How Retinoblastoma Is Treated

Treatment for retinoblastoma (a condition in which cancerous cells form in the eye's retina, the light-sensing tissue in the back of the eye) varies depending on the individual tumor's characteristics and where in the eye it is located. Currently, 9 out of 10 children with this condition are cured with the aid of proper treatment.

Approaches include the use of radiation, laser therapy, cryo treatment, chemotherapy, and surgery, if called for. The goal is to not only save the patient's life but also to preserve as much vision as possible.

This article discusses how these treatments work, their advantages and disadvantages, and what to know when considering the best treatment approach for your child.

A laser targeting a point in the eye

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Surgeries and Specialist-Driven Procedures

Retinoblastoma is a condition that usually affects young children and needs to be handled by a specialist. Such specialists can help to chart a course with the goal of ridding the tumor while sparing vision.

Part of the decision-making process will hinge on whether the tumor is still contained within the eye itself (intraocular retinoblastoma) or has spread elsewhere in the body, called an extraocular or metastatic tumor.

There are some common treatment strategies a specialist may recommend. These may be used individually or together.

Chemotherapy

One common treatment method for shrinking a retinoblastoma is chemotherapy. This treatment involves using drugs that kill fast-growing cancer cells, usually by keeping them from effectively dividing and making new cells.

The aim of chemotherapy in retinoblastoma cases is usually either to shrink tumors still in the eye or to kill off any lingering cells that may have made their way elsewhere in the body.

For retinoblastoma, different types of chemotherapy can be used, including the following:

  • Systemic
  • Intra-arterial
  • Intravitreal

With systemic chemotherapy, the drugs go right into the bloodstream. Usually, two or three drugs are given at once. These then circulate throughout the body. They are given in cycles lasting a few weeks at a time.

When the intra-arterial approach is used, the chemotherapy goes into the main artery of the eye. This method allows for much smaller doses of chemotherapy agents to be used. With smaller doses, it's possible to better control tumors and with fewer side effects.

With the intravitreal approach, chemotherapy drugs are injected with a very small needle right into the jelly-like substance in the eye known as the vitreous, with extra care to prevent tumor cell escape through the needle tract. In cases in which retinoblastoma tumors have not been effectively treated with other approaches, this may be combined with other chemotherapy.

Chemotherapy does bring with it side effects. These can include the following:

  • Appetite loss
  • Nausea
  • Vomiting
  • Loss of hair
  • Constipation
  • Diarrhea
  • Fatigue
  • Bruising
  • Raised infection risk

Radiation

With radiation therapy, the tumor cells are eradicated by high-energy X-ray particles. There are two different radiation approaches that may be tried here. The doctor may recommend an external beam approach, in which the radiation is aimed at the tumor while the child lies on a table. Typically, this treatment is given over five days for several weeks.

The treatment may bring with it short-term issues, such as some hair loss or a sunburn-like reaction on the skin, or it may result in more severe skin damage. It's also possible that the treatment may lead to a clouding of the lens known as a cataract. It also could damage the optic nerve or retina, causing a reduction in vision.

Because radiation can slow the growth of bones in the area being treated, another downside is that this can affect the appearance of the eye. Also, if external radiation therapy is given, the chances of developing other types of cancer in the area increase.

The other approach is what's known as plaque radiotherapy, or brachytherapy, a type of internal radiation therapy. With this approach, a tiny amount of radioactive material is temporarily placed near the tumor. The radioactive material does not affect nearby healthy tissue.

This radioactive plaque is usually sewn into place during one short procedure and removed several days later during another.

This internal approach causes fewer side effects than its external counterpart. Brachytherapy can, however, cause problems to the optic nerve or retina months down the line, although with advances in technique in recent years, this is less likely to happen.

Laser

Laser therapy may be used for retinoblastoma. Two types are photocoagulation and transpupillary thermal therapy (TTT).

With photocoagulation, different strengths of light can be used to target tumors. The laser heats the blood vessels that feed the tumor, destroying them. This therapy tends only to be effective for certain smaller tumors located at the back of the eye.

The downside here is that blind spots can develop from damage to the retina, and the retina can temporarily detach in some cases.

With transpupillary thermal therapy, infrared light is directed at the tumor, with the heat slowly destroying the cancer cells. Since the temperature used here is not as high as with photocoagulation, this may spare retinal blood vessels.

One downside here is that with transpupillary thermal therapy, some shrinkage of the colored part of the eye may result. This can lead to lens clouding or retinal damage, impacting vision.

Cryotherapy

With this approach, a probe is placed on the outside of the eye to freeze the tumor. This can be useful in cases of smaller retinoblastoma tumors and may have to be repeated. It can be done on an outpatient basis.

One downside is that it can cause the eye to temporarily swell so much that the child may not be able to open the lid for the first few days. Also, this can lead to blind spots from damage to the retina, as well as retinal detachment.

Surgery

If the retinoblastoma can't be controlled by other methods, it may be necessary to surgically remove the eye. This would keep the cancer from spreading elsewhere.

Once the eye is removed, it can be replaced with an artificial one that can even be attached to the eye muscles. This means that even though the eye cannot see, it will look natural.

Over-the-Counter (OTC) Therapies

Your child's doctor may recommend some over-the-counter treatments, such as pain relievers to help manage some of the side effects of needed treatments. While these measures may be very helpful and seem intuitive, be sure to double-check with your child's medical team before offering even seemingly simple options.

Complementary and Alternative Medicine (CAM)

In addition to standard treatments for retinoblastoma, you may hear about approaches such as herbs, vitamins, minerals, acupuncture, and massage that some are touting.

First, keep in mind the difference between complementary and alternative approaches. A complementary approach is something that you may use along with standard treatments.

This may include something that helps to minimize side effects of traditional therapy such as the nausea caused by chemotherapy. While this may be helpful, before using any such approach, confer with your child's medical team to ensure that treatments do not conflict with other measures.

Meanwhile, alternative medicine is something that may be used instead of traditional techniques. Keep in mind that many of these approaches are not backed by scientific data and should be viewed skeptically. If too much time is lost to these approaches, other standard therapy may no longer be an option for your child.

Summary

For children with retinoblastoma, a variety of treatment approaches can be used. A specially selected medical team will help you to effectively navigate option, such as chemotherapy, radiation, cryotherapy, laser treatment, and surgery. These may be used alone or, in some cases, in combination in combating retinoblastoma.

A Word From Verywell

Regarding retinoblastoma, fortunately, there is a variety of effective options to consider. Many of the treatments can help preserve vision and also work to ensure that your child's eye disease does not progress.

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9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  7. Memorial Sloan Kettering Cancer Center. Retinoblastoma treatment.

  8. American Cancer Society. Cryotherapy for retinoblastoma.

  9. American Academy of Ophthalmology. Retinoblastoma diagnosis and treatment.