The best treatments for your child's retinoblastoma depend on the size and location of the tumor, whether cancer has spread to areas other than the eye, your child's overall health, and your own preferences. The goal of treatment is to cure the cancer. When possible, your child's doctor will also work to preserve your child's vision.
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy can be taken in pill form or given through a blood vessel. Chemotherapy drugs travel throughout the body to kill cancer cells.
In children with retinoblastoma, chemotherapy may help shrink a tumor so that another treatment, such as radiation therapy, cryotherapy, or laser therapy, may be used to treat the remaining cancer cells. This may improve the chances that your child won't need surgery.
Chemotherapy may also be used to treat retinoblastoma that has spread to tissues outside the eyeball or to other areas of the body.
A new type of chemotherapy, known as intra-arterial chemotherapy, delivers the drug directly to the tumor through a tiny tube (catheter) in an artery in the eye. In some cases, the doctor will put a tiny balloon in the artery to keep the medicine close to the tumor. This type of chemotherapy can be given as the initial treatment or be used when the tumor does not respond to a different type of treatment.
Intravitreal chemotherapy is also used to treat retinoblastoma that has spread within the eye. In this type of chemotherapy, drugs are injected directly into the eye. Intravitreal chemotherapy is used when the cancer does not respond to other treatments.
Radiation therapy uses high-energy beams, such as X-rays and protons, to kill cancer cells. Two types of radiation therapy used in treating retinoblastoma include:
Internal radiation (brachytherapy). During internal radiation, the treatment device is temporarily placed in or near the tumor.
Internal radiation for retinoblastoma uses a small disk made of radioactive material. The disk is stitched in place and left for a few days while it slowly gives off radiation to the tumor.
Placing radiation near the tumor reduces the chance that treatment will affect healthy eye tissue.
External beam radiation. External beam radiation delivers high-powered beams to the tumor from a large machine outside of the body. As your child lies on a table, the machine moves around your child, delivering the radiation.
External beam radiation can cause side effects when radiation beams reach the delicate areas around the eye, such as the brain. For this reason, external beam radiation is typically reserved for children with advanced retinoblastoma and those for whom other treatments haven't worked.
Laser therapy (laser photocoagulation)
During laser therapy, a laser is used to destroy blood vessels that supply oxygen and nutrients to the tumor. Without a source for fuel, cancer cells may die.
Cold treatments (cryotherapy)
Cryotherapy uses extreme cold to kill cancer cells.
During cryotherapy, a very cold substance, such as liquid nitrogen, is placed in or near the cancer cells. Once the cells freeze, the cold substance is removed and the cells thaw. This process of freezing and thawing, repeated a few times in each cryotherapy session, causes the cancerous cells to die.
When the tumor is too large to be treated by other methods, surgery may be used to treat retinoblastoma. In these situations, surgery to remove the eye may help prevent the spread of cancer to other parts of the body. Surgery for retinoblastoma includes:
- Surgery to remove the affected eye (enucleation). During surgery to remove the eye, surgeons disconnect the muscles and tissue around the eye and remove the eyeball. A portion of the optic nerve, which extends from the back of the eye into the brain, also is removed.
Surgery to place an eye implant. Immediately after the eyeball is removed, the surgeon places a special ball — made of plastic or other materials — in the eye socket. The muscles that control eye movement are attached to the implant.
After your child heals, the eye muscles will adapt to the implanted eyeball, so it may move just as the natural eye did. However, the implanted eyeball cannot see.
Fitting an artificial eye. Several weeks after surgery, a custom-made artificial eye can be placed over the eye implant. The artificial eye can be made to match your child's healthy eye.
The artificial eye sits behind the eyelids and clips onto the eye implant. As your child's eye muscles move the eye implant, it will appear that your child is moving the artificial eye.
Side effects of surgery include infection and bleeding. Removing an eye will affect your child's vision, though most children will adapt to the loss of an eye over time.
Clinical trials are studies to test new treatments and new ways of using existing treatments. While clinical trials give your child a chance to try the latest in retinoblastoma treatments, they can't guarantee a cure.
Ask your child's doctor whether your child is eligible to participate in clinical trials. Your child's doctor can discuss the benefits and risks of enrolling in a clinical trial.