Treatment

Treatment is performed to first and foremost save your child's life and control overall symptoms. We also want to preserve the vision and save the eye.

Methods of Treatment
  • Laser
    Some tumors may be eliminated using laser alone, or supplemented by chemotherapy. To enhance the effect of primary chemotherapy after a reduction in tumor size, a laser beam is applied to the outer margin of the tumor and works by cutting off the blood supply to the tumor. To enhance the effect of chemotherapy, the laser is applied to the surface of the tumor to heat it and increase the uptake of chemotherapy drug into the tumor, which is typically used for recurrent tumors.

  • Cryotherapy
    Smaller tumors located in the periphery of the retina at the front of the eye can be treated through freezing. This is carried out under general anaestheic using an instrument called a cryoprobe which is placed on the outer surface of the eye, overlying the base of the tumor. The tumor cells are killed by being frozen, which may require the procedure to be repeated over the span of several weeks. The eyelids may be a bit puffy or sore for a few days after cryotherapy, and the child will require eyedrops for several days post treatment.

  • Chemotherapy
    This first stage drug treatment is used in for most patients who have bilateral RB (cancer in both eyes), and can be applied to both small and large tumors. It can be used for unilateral RB (cancer in one eye), but only in cases where the tumor is small and there is a high chance of preserving vision in the eye.

    Chemotherapy is given through a central IV line that will remain for the duration of the therapy, which is a tube inserted into the main vein that drains into the heart.

    Short term side effects of chemotherapy may include nausea and vomiting (which can be counteracted by various drugs), increased susceptibility to infection, tendency for bruising, and temporary hair loss. Hair can be grown back normally after the treatment has been concluded. In the child's future, fertility will not be impaired by the drugs applied in this treatment.

  • Brachytherapy (radioactive plaques)
    In some cases of tumors 6-12 mm in size, radioactive sclera plaque can be used to treat the tumor using radioactive iodine or ruthenium. This is applied when there is only one tumor which must be situated away from the optic nerve and the light sensitive portion of the ey called the macula. The child will need to be in isolation for 1-3 days, though it is usually possible for one parent to stay in the room with the child as long as their bed is an appropriate distance from the child. They will require general anesthetic to insert the plaque. Chemotherapy may be given beforehand to shrink the tumor before this treatment.

  • Radiotherapy
    This is considered a second line therapy for tumors that have failed to respond to chemotherapy or from recurrent tumors following primary chemotherapy. The treatment is given daily over a period of 4-5 weeks. The child is given general anesthetic to ensure that they remain entirely still for the treatment. It only lasts roughly 2-3 minutes each day, but it requires a lot of preparation to align the beam accurately on the tumors in the retina.

  • Surgical removal of the eye (enucleation)
    Surgery may be required if the tumor is large and has damaged the eyesight beyond repair. This is only carried out if all other treatments will not be considered effective, and the tumor is putting the child's life at risk. This is only recommended after everything else has been done to try to preserve vision.

    Recovery is very fast, and the operation itself is usually not particularly painful. The child can typically go home within one or two days following surgery, and you will be instructed on how to use antibiotic drops to the socket to prevent infection. A clear or eye colored conformer will be inserted to protect the socket while healing.
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