Treatments for intraocular retinoblastoma

Intraocular retinoblastoma is retinoblastoma that is contained within the eye and has not spread to other parts of the body. The treatment for intraocular retinoblastoma depends on:

• whether the cancer is in one or both eyes
• the number of tumours in the eye
• the size of the tumour or tumours in the eye
• whether or not your child’s doctor feels that your child’s vision can be saved

Treatment for smaller tumours usually consists of a local therapy (cryosurgery, thermotherapy or laser surgery). This may be followed by chemotherapy.

Treatment for larger tumours may use plaque brachytherapy or chemotherapy. Chemotherapy is used to try to shrink the tumour so that local therapies can be used to treat it. If the tumour doesn’t respond to treatment, external beam radiation therapy may be given. Surgery may be used to remove the eye if the eye is no longer working or if the tumour does not respond to other treatments.

The following are treatment options for intraocular retinoblastoma. The healthcare team will suggest treatments based on your child’s needs and work with you and your child to develop a treatment plan.

Cryosurgery is commonly used to treat intraocular retinoblastoma. Cryosurgery uses extreme cold to freeze and destroy cancer cells. It may also be used to treat retinoblastoma that comes back (recurs) within the eye.

Thermotherapy is commonly used to treat intraocular retinoblastoma. Thermotherapy uses microwaves, ultrasound or infrared radiation to deliver heat to and destroy cancer cells. It may also be used to treat retinoblastoma that comes back within the eye.

Laser surgery is commonly used to treat intraocular retinoblastoma. Laser surgery uses a laser (a powerful beam of light) to heat and destroy cancer cells. It may also be used to treat retinoblastoma that comes back within the eye.

Your child may be offered chemotherapy for intraocular retinoblastoma. Chemotherapy may be used along with local treatments (cryosurgery, thermotherapy or laser surgery). Chemotherapy may also be used after surgery to reduce the risk of cancer coming back. Chemotherapy for intraocular retinoblastoma may be systemic or regional. The type of chemotherapy used along with local therapy may depend on the size of the tumour or tumours in the eye. If there are large tumours in both eyes, chemotherapy may be used first to try to shrink the tumours and avoid surgery in both eyes. The order of local therapies and chemotherapy will depend on your child’s treatment plan, whether they are enrolled in a clinical trial, and other factors such as the healthcare team’s expertise and the treatment centre’s experience.

The most common combination of chemotherapy drugs used is carboplatin, etoposide and vincristine. When used in combination, these chemotherapy drugs are usually given through a needle in a vein (intravenously).

Your child may be offered radiation therapy for intraocular retinoblastoma. Plaque radiation therapy uses a radioactive material that is placed directly on the eye. Plaque radiation therapy is most commonly used to treat intraocular retinoblastoma. External beam radiation therapy may be used for intraocular retinoblastoma in both eyes that does not respond to other treatments.

Your child may be offered surgery to remove the eye (called enucleation) for intraocular retinoblastoma if the tumour is very large, if vision is unlikely to be preserved or if the retinoblastoma does not respond to other treatments. Chemotherapy may be given after surgery to reduce the risk of cancer coming back.

Many children with retinoblastoma are treated in a clinical trial. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.