Treatment

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, doctors try to choose treatments that won't result in removal of the eye or a loss of vision.

Chemotherapy

Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. In children with retinoblastoma, chemotherapy may help shrink a tumor so that another treatment, such as 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 to remove the eye.

Types of chemotherapy used to treat retinoblastoma include:

• Chemotherapy that travels through the entire body. Chemotherapy drugs that are given through a blood vessel will travel throughout the body to kill cancer cells.
• Chemotherapy injected near the tumor. A specialized type of chemotherapy, known as intra-arterial chemotherapy, delivers the medicine directly to the tumor through a tiny tube (catheter) in an artery supplying blood to the eye. The doctor might put a tiny balloon in the artery to keep the medicine close to the tumor.
• Chemotherapy administered into the eye. Intravitreal chemotherapy involves injecting chemotherapy drugs directly into the eye.

Radiation therapy

Radiation therapy uses high-powered energy, such as X-rays and protons, to kill cancer cells. Types of radiation therapy used in treating retinoblastoma include:

• Local radiation. During local radiation, also called plaque radiotherapy or brachytherapy, the treatment device is temporarily placed near the tumor.

  Local radiation for retinoblastoma uses a small disk containing seeds 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 tissues outside the eye. This type of radiotherapy is typically used for tumors that don't respond to chemotherapy.

• 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.

Laser therapy (transpupillary thermotherapy)

During laser therapy, a heat laser is used to directly destroy the tumor cells.

Cold treatment (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.

Eye removal surgery

When the cancer is too large to be treated by other methods, surgery to remove the eye may be used to treat retinoblastoma. In these situations, eye removal may help prevent the spread of cancer to other parts of the body. Eye removal 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 sometimes 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. 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. Your child may need to wear special shatter-resistant glasses and sport goggles at all times to protect the remaining eye.

Clinical trials

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.