Targeted Retinoblastoma Management
Targeted Retinoblastoma Management
In this report, we emphasized the importance of accuracy in retinoblastoma diagnosis as there are over 25 conditions that can simulate retinoblastoma with a yellow-white intraocular mass. The clinician should be fully capable of differentiating the simulators to avoid misdiagnosis and mistaken therapy. There are several chemotherapy alternatives for retinoblastoma, using IVC, IAC, POC, and IVitC. The chemotherapy strategy depends on whether the patient has germline or nongermline mutation as well as tumor laterality and stage of disease. If bilateral (germline) retinoblastoma, IVC is important as first line therapy for control of intraocular disease, prevention of metastasis, and reduction in prevalence of pineoblastoma and long-term second malignant neoplasms. Bilateral groups D and E retinoblastoma receive additional POC with a carboplatin or topotecan boost for improved local control. Occasionally, groups D and E are managed with combined IVC then with IAC, particularly if the advanced disease is bilateral or it is the child's only eye. If unilateral (nongermline) retinoblastoma is present, then IAC is considered. IAC is also a powerful salvage therapy following failure after chemoreduction or other methods. IVitC is reserved for recurrent vitreous seeds following other therapies. In conclusion, the chosen strategy for retinoblastoma management with chemotherapy depends on several factors.
Conclusion
In this report, we emphasized the importance of accuracy in retinoblastoma diagnosis as there are over 25 conditions that can simulate retinoblastoma with a yellow-white intraocular mass. The clinician should be fully capable of differentiating the simulators to avoid misdiagnosis and mistaken therapy. There are several chemotherapy alternatives for retinoblastoma, using IVC, IAC, POC, and IVitC. The chemotherapy strategy depends on whether the patient has germline or nongermline mutation as well as tumor laterality and stage of disease. If bilateral (germline) retinoblastoma, IVC is important as first line therapy for control of intraocular disease, prevention of metastasis, and reduction in prevalence of pineoblastoma and long-term second malignant neoplasms. Bilateral groups D and E retinoblastoma receive additional POC with a carboplatin or topotecan boost for improved local control. Occasionally, groups D and E are managed with combined IVC then with IAC, particularly if the advanced disease is bilateral or it is the child's only eye. If unilateral (nongermline) retinoblastoma is present, then IAC is considered. IAC is also a powerful salvage therapy following failure after chemoreduction or other methods. IVitC is reserved for recurrent vitreous seeds following other therapies. In conclusion, the chosen strategy for retinoblastoma management with chemotherapy depends on several factors.
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