Retinoblastoma (RB) is the most common primary ocular malignancy of young children. Approximately 8,000 children are diagnosed with RB worldwide annually. If caught early RB can be cured, preserving life, vision, and the eye(s). At our institution, the treatment of retinoblastoma has evolved dramatically over the past decade. Utilization of focal therapies has transformed our treatment algorithms, patient outcomes and nursing care; our RB overall survival exceeds international rates. Localized treatments include chemotherapy administered directly into the eye via the ophthalmic artery or intra-vitreously, laser photocoagulation, cryotherapy, and, in cases of very advanced eyes, plaque brachytherapy or enucleation.
Children with RB are often treated with six or more cycles of systemic chemotherapy as a “chemoreduction” strategy using etoposide, carboplatin, and vincristine; this places the child at risk for serious potential side effects such as febrile neutropenia, ototoxicity, neurotoxicity, and the risk of secondary leukemia. We have virtually eliminated the use of systemic chemotherapy, utilizing it only in the presence of metastatic disease or in the youngest of patients too small for ophthalmic artery chemotherapy. We also no longer utilize external beam radiotherapy which has been shown to substantially increase the risk of secondary cancers in children with a heritable form of RB. The use of localized treatments reduces systemic morbidity, inpatient admissions, the need for central venous access, and overall healthcare costs, while not compromising curability. Pediatric oncology nurses need to be familiar with localized treatment options for RB to be able to comprehensively educate parents about therapy effectiveness and potential side effects, enhancing informed decision making.
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