Unilateral Retinoblastoma (ICRB Group A or Group B, Macular-Sparing) — After Globe Salvage Therapy Failure
Clinical Scenario
This protocol applies to unilateral retinoblastoma classified as ICRB Group A or ICRB Group B with macular sparing (small tumor), in the absence of high-risk features such as extraocular extension or choroidal or optic nerve invasion. It is reached when the preceding globe salvage effort has not achieved its goals.
Previous Treatment — Failure Condition
Prior globe salvage therapy — which may have included approaches such as cryotherapy, thermotherapy (TTT), intra-arterial chemotherapy (IAC), intravitreal chemotherapy (IvitC), precision intravitreal chemotherapy (p-IvitC), intracameral chemotherapy (IcamC), and/or plaque radiotherapy — did not achieve control and resolution of vitreous and subretinal seeds with tumor regression. This protocol defines the next step taken after that failure.
Treatment Approach (Partial Overview)
When globe salvage options have been exhausted, the approach for this population centres on surgical intervention targeting the affected eye. Depending on histopathological findings after surgery, additional systemic therapy may be indicated. The complete regimen — including the full indications, sequencing criteria, and supplemental treatment components — is detailed in the structured protocol.
References
DOI: 10.4103/ijo.IJO_721_20
- As with cryotherapy, TTT can be used in combination with chemotherapy as primary treatment for small tumors less than 3 mm in diameter and 2 mm in thickness.
- Indications include treatment of small tumors and foci of sub retinal or preretinal seeds.
- It is usually reserved for massive group E tumors, poor tumor visualization (e.g., due to vitreous hemorrhage), presence of extraocular extension, suspected invasion of the optic nerve or choroid, or recalcitrant tumors that have failed previous globe salvage therapies (e.g., IAC, IvitC, plaque radiotherapy, etc.).
- High risk retinoblastoma warrants enucleation and additional 6‑9 cycles of high‑dose IVC to prevent metastatic disease.
- In the presence of high risk features, including post‑laminar optic nerve invasion, massive choroidal invasion (>3 mm diameter), or extraocular extension, adjuvant IVC is required for prevention of metastases.
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