Conservative treatment modalities in retinoblastoma

Area of Science:

• Ophthalmology
• Pediatric Oncology
• Cancer Treatment

Background:

• Retinoblastoma is the most common primary intraocular malignancy in children.
• Significant advancements have improved the curability and treatment outcomes for retinoblastoma.
• Enucleation is the standard for advanced intraocular tumors, but globe salvage is increasingly prioritized.

Purpose of the Study:

• To review the literature on conservative treatment modalities for retinoblastoma.
• To evaluate the effectiveness of these treatments when used alone or in combination.
• To highlight options that preserve vision and minimize long-term side effects.

Main Methods:

• Comprehensive literature search of Pubmed, Medline, Embase, and Cochrane Library up to 2012.
• Inclusion of peer-reviewed data on conservative retinoblastoma treatment modalities.
• Analysis of systemic chemotherapy, focal consolidation, laser therapy, brachytherapy, and local chemotherapy routes.

Main Results:

• Conservative modalities can achieve globe salvage and preserve useful vision, reducing the need for enucleation or external beam radiotherapy.
• Radioactive plaque brachytherapy is effective for selected intraocular retinoblastoma cases.
• Local chemotherapy (subconjunctival, sub-tenon, intra-arterial) shows promise, particularly intra-arterial melphalan, often as an adjunct to systemic therapy.

Conclusions:

• Multiple conservative treatment options exist for retinoblastoma, potentially obviating enucleation.
• These treatments can cure retinoblastoma while preserving functional vision.
• A thorough understanding of conservative modalities is crucial for optimal patient management.