Philippine Journal of Ophthalmology (Jun 2005)
Globe-sparing interventions in the management of intraocular retinoblastoma
Abstract
RETINOBLASTOMA is the most common malignant intraocular tumor in children; it is also one of the most highly curable pediatric solid tumors if detected early. The conventional treatment of retinoblastoma is primary enucleation. Recent research reported a trend toward decreasing frequency of enucleation in the management of retinoblastoma.1 The trend toward globesparing interventions has been largely attributed to earlier diagnosis and recent success with conservative globe-sparing treatment options. Currently, globesparing interventions include first-line chemotherapy or chemoreduction, subconjunctival chemotherapy, systemic chemotherapy for metastasis, transpupillary thermotherapy (TTT), chemothermotherapy (CTT), laser photocoagulation, cryotherapy, brachytherapy, and external beam radiotherapy (EBRT). Expanded clinical options currently available have markedly decreased the overall enucleation rate for retinoblastoma.2 CLINICAL SCENARIO: A 10-month old boy is brought to an ophthalmologist because of cat’s eye reflex in the left eye. The patient had undergone enucleation of his right eye for glaucomatous stage retinoblastoma 6 months earlier. Examination revealed the presence of a solitary retinal mass of about 12 mm in diameter, located nasal to the disc. There was no evidence of vitreous seeding. Realizing that this was the only eye of the patient, the ophthalmologist wants to do everything humanly possible to preserve it. He has heard about chemothermotherapy (CTT) but is not sure if this was the best alternative he can offer. CLINICAL QUESTION: Among patients with retinoblastoma, is chemoreduction combined with adjuvant treatment effective in preserving the globe and vision? SEARCH METHOD: An electronic search of the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) on The Cochrane Library (Issue 1 2005) and MEDLINE on PubMed was performed. The literature search was limited to the English language with no date restrictions. The search terms used were retinoblastoma and chemothermo-therapy, thermochemotherapy, or chemoreduction. The search yielded 70 articles, 22 were chosen for evaluation and 8 were included in the review. Two reviewers independently assessed the articles for inclusion. Selection criteria: This review was designed to include clinical trials in which treatment of retinoblastoma with chemoreduction combined with adjuvant therapy was compared with another treatment or no treatment. CITATIONS: 1. Schiavetti A, Hajistilianou T, Clerico A, et al. Conservative therapy in intraocular retinoblastoma: response/ recurrence rate. J Pediatr Hematol Oncol 2005; 27: 3-6.
