Retinoblastoma: Treatment Options

Abstract

Survival rates for retinoblastoma patients have increased dramatically over the past century, with documented 5-year survival reaching 95–99 % in developed countries. Similarly, there have been significant advances in the treatment approaches for intraocular retinoblastoma, driven by a motivation to increase salvage rates and decrease complications. Over the past 50 years, there have been major paradigm shifts in the approaches for managing intraocular retinoblastoma. In the 1960s, external radiation therapy was the primary vision-saving modality for treating the ocular tumors. In the mid 1990s, systemic chemotherapy combined with focal modalities became the dominant treatment strategy, emphasizing multiple drug chemoreduction protocols and minimizing the use of external beam radiation. Over the past 5 years, there has been growing interest in local or regional therapies, delivering chemotherapeutic agents directly to the globe or through regional arteries in an attempt to improve cure rates and reduce the morbidity of less selective modalities. In this chapter, we summarize current management approaches for intraocular retinoblastoma, emphasizing the clinical indications for intravenous chemotherapy, external beam radiation, brachytherapy, focal modalities, intra-arterial chemotherapy, and intravitreal injection of chemotherapy.