If the examination shows a great amount of disease in one eye, treatment may include removal of that eye. If both eyes are involved, current treatment approaches are available to make every effort to try to save at least one eye. Removal of your child's eye is done only when the disease has progressed beyond hope of saving useful vision.
The treatment depends on the size and location of the tumor and whether the tumor has spread. Rarely, retinoblastoma can spread to places outside of the eye as well. The most common places are the bone marrow, the central nervous system and the bones. After diagnosis, a number of tests will be done to see if the tumor cells have spread. These tests may include a bone marrow aspirate and biopsy, spinal tap, CT scans, MRI and bone scans. Several types of treatment are available. These include surgery, chemotherapy, cryotherapy and laser therapy, and radiation. Surgery and chemotherapy are the most common treatments for retinoblastoma. Cryotherapy and laser therapy are used for small tumors, less than 6mm in size.
Complications of radiation therapy can include slight damage to the blood vessels, which should not reduce vision. Radiation can eventually lead to glaucoma, increased pressure in the eye. Radiation of the lens of the eye can result in cataracts, clouding of the lens of the eye. Radiation also has cosmetic consequences due to effects on orbital bone growth. In advanced cases surgery to remove the effected eye is the usual treatment. Cryotherapy, or freezing of the tumor, with or without chemotherapy, may be used to treat small localized tumors.
When surgery is finished, your child may be given chemotherapy to destroy any remaining traces of disease. Some of the chemotherapy medicines may be carboplatin, etoposide (VP-16), vincristine, cyclophosphamide, ifosfamide, doxorubicin and topotecan. These drugs have all been found to be somewhat effective against retinoblastoma and may be used alone or in combinations for a course of chemotherapy.
Local chemotherapy is used for large tumors. Chemotherapy can be delivered to the tumor by a more direct route via the arteries within the eye. Side effects of this chemotherapy include swelling of the eyelid, bleeding into the eye, eye muscle dysfunction, drooping of the upper eyelid, or harm to the artery.
After the treatment is completed, the child will receive periodic check-ups, including eye examinations under anesthesia and follow-up with an oncologist. If needed, your child can be fitted with a prosthesis or glass eye.