New challenges in retinoblastoma treatment

Purpose Retinoblastoma treatment has changed during the past ten years with the introduction of intraarterial and intravitreal chemotherapy. There is a trend to more conservative management and the challenge is to decide when to enucleate. Methods We have made a retrospective study of patients treated in 2013 and 2014.Unilateral retinoblastoma were treated by intraarterial melphalan and local treatments in selected cases and enucleation for advanced group D and for all group E eyes For bilateral retinoblastoma, conservative management was proposed with intravenous chemotherapy and local treatments Follow up every month under general anesthesia during the first year with treatment of small recurrences by laser or cryotherapy was performed Results There were 40 bilateral retinoblastoma and 4 of them were metachronous.19 patients received 6 courses of 3 drugs and 21 received two courses of VP16 and carboplatin followed by carboplatin. All the children had local ophthalmological treatments started at the third cycle. 21 children kept both eyes and 19 kept one eye. There were 72 unilateral retinoblastoma .43 (60%) were treated with primary enucleation and 29 (40%) were treated by conservative management. 21 of these eyes were saved and 8 were secondary enucleated. No patient developed orbital recurrence, optic nerve involvement or metastasis. Conclusions The increase of conservative management in retinoblastoma is safe with proper selection of eyes and close follows up.