Conservative management of retinoblastoma: Challenging orthodoxy without compromising the state of metastatic grace. “Alive, with good vision and no comorbidity”

Publication date: Available online 5 June 2019Source: Progress in Retinal and Eye ResearchAuthor(s): Francis L. Munier, Maja Beck-Popovic, Guillermo L. Chantada, David Cobrinik, Tero T. Kivelä, Dietmar Lohmann, Philippe Maeder, Annette C. Moll, Angel Montero Carcaboso, Alexandre Moulin, Paula Schaiquevich, Ciara Bergin, Paul J. Dyson, Susan Houghton, Francesco Puccinelli, Yvan Vial, Marie-Claire Gaillard, Christina StathopoulosAbstractRetinoblastoma is lethal by metastasis if left untreated, so the primary goal of therapy is to preserve life, with ocular survival, visual preservation and quality of life as secondary aims. Historically, enucleation was the first successful therapeutic approach to decrease mortality, followed over 100 years ago by the first eye salvage attempts with radiotherapy. This led to the empiric delineation of a window for conservative management subject to a “state of metastatic grace” never to be violated.Over the last two decades, conservative management of retinoblastoma witnessed an impressive acceleration of improvements, culminating in two major paradigm shifts in therapeutic strategy. Firstly, the introduction of systemic chemotherapy and focal treatments in the late 1990s enabled radiotherapy to be progressively abandoned. Around 10 years later, the advent of chemotherapy in situ, with the capitalization of new routes of targeted drug delivery, namely intra-arterial, intravitreal and now intracameral injections, allowed significant increas...

Source: Progress in Retinal and Eye Research - June 5, 2019 Category: Opthalmology Source Type: research