1. What is the treatment?

2. Treatment of Retinoblastoma Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team. Children with retinoblastoma should have their treatment planned by a team of doctors with expertise in treating cancer in children. Late effects of cancer treatment may include physical problems; changes in mood, feelings, thinking, learning or memory; and second cancers (new types of cancer.) Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. http://www.enotalone.com/article/7563.html

3. For the Patient Chemotherapy- initial Enucleation- if unsuccessful

4. Medical Chemotherapy  Preservation of normal vision  Primary neoadjuvant chemotherapy or chemoreduction has been the most significant recent advance in the treatment of retinoblastoma.  Prophylactic chemotherapy is recommended if a tumor is in the optic nerve past the lamina cribrosa because these cases have a poor survival prognosis.  Use of neoadjuvant chemotherapy has the advantage of limiting the necessity for EBRT and reducing the possibility of EBRT-related complications.

5. Surgical Enucleation  Enucleation is performed when there is no chance of preserving useful vision in an eye.  Treatment of choice for large retinoblastomas  Indicated for: patients who present with total retinal detachments and/or the posterior segment is full of the tumor, in which case it is clear the patient cannot retain any form of useful vision.

6. Other Options External beam radiation therapy  Indications: o For eyes with significant vitreous seeding o For children who have progression of disease while undergoing chemoreduction o For tumors extending up to or beyond the cut margin of the optic nerve of an enucleated eye  Advantages: incidence of local control is high and retinal late effects are minimal  Disadvantages: cessation of bone growth, 6-fold increase in development of cancer in the patient’s lifetime

7. Other Options Radioactive isotope plaques  Advantage: locally directed treatment to the tumor, minimizing radiation to the normal tissue  Disadvantage: incomplete treatment, high dose to local sclera, significantly less irradiation for anterior lesions, and difficulty placing posterior plaques

8. Other Options Intensity-modulated radiation therapy (IMRT)  A type of 3-dimensional (3-D) radiation therapy that uses a computer to make pictures of the size and shape of the tumor.  Thin beams of radiation of different intensities (strengths) are aimed at the tumor from many angles.  This type of radiation therapy causes less damage to healthy tissue near the tumor. Stereotactic radiation therapy  Radiation therapy that uses a rigid head frame attached to the skull to aim high-dose radiation beams directly at the tumors, causing less damage to nearby healthy tissue.  It is also called stereotactic external-beam radiation, stereotactic radiosurgery, and stereotaxic radiosurgery.  This procedure does not involve surgery.

9. Other options Cryotherapy – Can be used primarily for small anteriorly located tumors Photocoagulation – Can be used as primary therapy for small posteriorly located tumors