This depends on the number, position and size of the tumours in the eye. The aim of treatment is firstly to get rid of the cancer and secondly to try to keep the sight in the eye. Some treatments may cause changes to the vision in the affected eye. Your child’s specialist will talk to you about the possible risks as well as the advantages of the treatment.
Smaller tumours
For smaller tumours, treatment is given to the eye itself (called local therapy), while your child is asleep and under anaesthetic. One of the following methods may be used:
Cryotherapy
This is used to freeze the tumours. More than one session may be necessary, in which case they are usually done at monthly intervals.
Laser therapy
A laser is directed through the pupil and used to heat the tumour. Your child may need a number of sessions of laser therapy (under general anaesthetic) at intervals of 3 to 4 weeks.
Plaque
A small radioactive disc is stitched over the tumour on the outside of the eye. The disc needs to stay in place for up to four days while the radiation destroys the cancer cells. This is done for slightly larger tumours, or tumours that have not been successfully treated with other methods.
Thermotherapy
This process uses heat to destroy the cancer cells and may be combined with chemotherapy or radiotherapy, as heat can improve the effectiveness of these treatments. The heat is produced by a laser, which is directed at the tumour.
Larger tumours
These can be treated in a number of ways, including:
Chemotherapy
This is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It may be given before the local treatments mentioned above, to help shrink the tumour and make treatment more successful. Chemotherapy can also be used if the cancer has spread to other parts of the body, or if there’s a risk that it may spread. The chemotherapy drugs most commonly used to treat retinoblastoma are carboplatin, etoposide and vincristine.
There are newer techniques which include giving chemotherapy directly into the artery (the blood vessel) that supplies the eye (intra-arterial chemotherapy) or injecting chemotherapy into the central gelatinous part of the eye (intra-vitreal chemotherapy). These are generally used when the tumour has not responded to initial treatment and your clinical team will discuss which is most suitable for your child.
Surgery
If the tumour is very large and the vision in the eye is lost, your child may need an operation to remove the eye. The specialist will only do this if it is absolutely necessary. An artificial eye is then fitted.
Radiotherapy
Radiotherapy treats cancer by using high-energy rays from a machine to destroy the cancer cells, while doing as little harm as possible to normal cells. It can be given to the whole eye but does have some effect on the surrounding tissue. Radiotherapy for retinoblastoma is normally only used when other treatments have not worked well.