treat retinoblastoma (a condition in which cancer cells form in the retina of the eye, the light-sensitive tissue at the back of the eye) depends on the characteristics of an individual tumor and its location in the eye. Currently, 9 out of 10 children with the disease are cured with the help of proper treatment.
Methods include the use of radiation, laser therapy, cryotherapy, chemotherapy, and surgery, if needed. The goal is not only to save the patient’s life, but to preserve as much vision as possible.
This article discusses how these treatments work, their pros and cons, and what to know when considering the best treatment for your child.
Surgery and expert-driven procedures
Retinoblastoma is a disease that usually affects young children and needs to be managed by a specialist. These experts can help chart a course to eliminate the tumor while preserving vision.
Part of the decision-making process will depend on whether the tumor is still contained within the eye itself (intraocular retinoblastoma) or has spread to other parts of the body, known as extraocular or metastatic tumors.
A specialist may recommend some common treatment strategies. These can be used individually or together.
A common treatment for shrinking retinoblastoma is chemotherapy. This treatment involves the use of drugs that kill rapidly growing cancer cells, usually by preventing them from effectively dividing and making new cells.
The goal of chemotherapy in retinoblastoma cases is usually to shrink the tumor that is still in the eye, or to kill any remaining cells that may have made their way to other parts of the body.
For retinoblastoma, different types of chemotherapy can be used, including:
- inside the vitreous
With systemic chemotherapy, the drug goes directly into the bloodstream. Usually, two or three drugs are given at one time. These then circulate throughout the body. They are given in one cycle that lasts several weeks.
When using the intraarterial approach, the chemotherapy goes into the main arteries of the eye. This approach allows the use of much smaller doses of chemotherapy drugs. With smaller doses, better tumor control and fewer side effects can be achieved.
With the intravitreal method, chemotherapy drugs are injected directly into the jelly-like substance in the eye called the vitreous using a very small needle, with special care being taken to prevent tumor cells from escaping through the needle tract. This can be combined with other chemotherapy in cases where retinoblastoma tumors are not effectively treated with other methods.
Chemotherapy does have side effects. These can include the following:
- loss of appetite
- hair loss
- Blood stasis
- increased risk of infection
With radiation therapy, tumor cells are eradicated by high-energy X-ray particles. There are two different radiation methods to try here. Doctors may recommend a method of external beam radiation, in which radiation is aimed at the tumor while the child lies on a table. Typically, this treatment lasts five days for several weeks.
Treatment may cause short-term problems, such as some hair loss or a sunburn-like reaction on the skin, or it may lead to more serious skin damage. Treatment can also cause a clouding of the lens, called a cataract. It can also damage the optic nerve or retina, causing vision loss.
Because radiation can slow the growth of bone in the area being treated, another disadvantage is that it can affect the appearance of the eye. Also, if external radiation therapy is given, the chance of developing other types of cancer in the area also increases.
Another method is called plaque radiation therapy, or brachytherapy, a type of internal radiation therapy. With this method, a small amount of radioactive material is temporarily placed near the tumor. The radioactive material does not affect nearby healthy tissue.
This radioactive plaque is usually sutured in place in a brief procedure and removed in another procedure a few days later.
This inner method causes fewer side effects than the outer method. However, brachytherapy can cause problems to the optic nerve or retina months later, although this is unlikely to happen as technology has improved in recent years.
Laser therapy can be used for retinoblastoma.There are two types photocoagulation and transpupillary hyperthermia (TTT).
With photocoagulation, different intensities of light can be used to target tumors. The laser heats the blood vessels feeding the tumor, destroying them. This therapy tends to work only for certain smaller tumors located at the back of the eye.
On the downside, blind spots can result from damage to the retina, and in some cases the retina can be temporarily separated.
For transpupillary hyperthermia, infrared light is directed at the tumor, and the heat slowly destroys the cancer cells. Since the temperatures used here are not as high as photocoagulation, retinal blood vessels may be preserved.
One downside here is that with transpupillary hyperthermia, some constriction of the colored part of the eye may result. This can lead to clouding of the lens or damage to the retina, affecting vision.
With this method, a probe is placed on the outside of the eye to freeze the tumor. This is useful in the case of smaller retinoblastoma tumors and may need to be repeated. It can be done on an outpatient basis.
One downside is that it can cause temporary swelling of the eyes so that the child may not be able to open the lids for the first few days. Additionally, this can lead to retinal damage and retinal detachment leading to blind spots.
If retinoblastoma cannot be controlled by other methods, surgery may be necessary to remove the eye. This will prevent the cancer from spreading to other places.
Once the eye is removed, it can be replaced with an artificial one, which can even be attached to the eye muscles. This means it will look natural even if the eye can’t see it.
Over-the-Counter (OTC) Therapies
Your child’s doctor may recommend over-the-counter treatments, such as pain relievers, to help manage some of the side effects of the desired treatment. While these measures can be very helpful and seem intuitive, be sure to double-check with your child’s medical team before offering seemingly simple options.
Complementary and Alternative Medicine (CAM)
In addition to the standard treatments for retinoblastoma, you may also hear about herbs, vitamins, minerals, acupuncture, and massage that some people are touting.
First, remember the difference between complementary and alternative methods. Complementary methods are methods you can use with standard treatment.
This may include helping to reduce the side effects of traditional treatments, such as chemotherapy-induced nausea. While this may be helpful, check with your child’s medical team before using any of these methods to ensure that treatment does not conflict with other measures.
Meanwhile, alternative medicine is something that can be used to replace traditional techniques. Keep in mind that many of these methods are not backed by scientific data and should be viewed with skepticism. If these methods waste too much time, other standard treatments may no longer work for your child.
For children with retinoblastoma, a variety of treatments are available. A specially selected medical team will help you effectively navigate options such as chemotherapy, radiation therapy, cryotherapy, laser therapy and surgery. These can be used alone, or in some cases, in combination to fight retinoblastoma.
With regard to retinoblastoma, fortunately, there are several effective options to consider. Many treatments can help preserve vision and also ensure your child’s eye disease doesn’t get worse.