Recent Trends in the Management of Retinoblastoma

Abstract

Retinoblastoma is the most common intraocular malignancy of childhood. Significant progress has been made in the past few years in the management of retinoblastoma. Thus, the patients' survival and ocular salvage rates have shown marked improvement. The current treatment strategies for retinoblastoma include enucleation, intravenous chemoreduction, and intra-arterial chemotherapy. Enucleation is generally reserved for eyes with extensive retinoblastoma, in which there is no hope for useful vision. From mid-1990s, intravenous chemoreduction has been used efficiently in the management of group A, B, or C, and some D eyes according to the International Classification of Retinoblastoma. Intravenous chemoreduction combined with focal treatments (cryotherapy, transpupillary thermotherapy, and brachytherapy) have provided favorable tumor control for most of these eyes. In 2008, superselective intra-arterial chemotherapy has been popularized. This treatment involves injection of a chemotherapeutic agent (mostly melphalan) after selective catheterization of the ophthalmic artery under neuroradiologic intervention. This provides higher success in advanced group D and Group E eyes that have relatively lower rate of tumor control with conventional intravenous chemoreduction. In conclusion, significant advances that have emerged recently in the management of retinoblastoma led to an increase in ocular salvage rates. Recently, popularized modality of intra-arterial chemotherapy offers hope in the control of eyes with advanced retinoblastoma.