| Radiotherapy |
Brachytherapy (plaque radiotherapy) |
Use of high-energy radiation from a plague placed on the sclera of the eye |
Solitary (or at most two foci), medium-sized tumours (6–15 mm) located away from the fovea and optic nerve |
Risk of secondary cancer, eye dryness, cataract, retinopathy, glaucoma, optic neuropathy, scleral necrosis, strabismus, and skin reaction |
| Tumour consolidation following chemoreduction |
| Residual or recurrent small-volume, active retinoblastoma |
| External beam radiation therapy |
High-energy radiation from an external source |
Multifocal large tumours unresponsive to focal therapies and chemotherapy |
High risk of secondary cancer, cataract, dry eye, foggy vision, corneal vascularization, bony orbital abnormalities, skin reaction |
| Tumours close to the macula or optic nerve |
| Retinoblastoma with vitreous seeding |
| As consolidation therapy after systemic therapy of metastatic tumour |
| Cryotherapy |
|
Freezing of tumour cells using a nitrogen oxide probe |
Small (<3.5 mm base and <2 mm thickness) tumours anterior to the equator. Tumour consolidation following chemoreduction for more advanced tumours |
Damage to the retina, including retinal tears, retinal detachment, retinal fibrosis, proliferative vitreoretinopathy, and chorioretinal atrophy |
| Laser therapy |
Photocoagulation |
Use of a laser beam to heat up and destroy blood vessels around the tumour |
Small (<4.5 mm at the base and <2.5 mm thick) posterior tumours |
Vascular occlusions, retinal traction, and retinal detachment |
| Tumour consolidation post chemoreduction |
| Tumour-associated retinal neovascularization |
| Thermotherapy (transpupillary thermal therapy) |
Use of infrared light to direct sub-photocoagulation heat to the tumour |
Small (<3 mm) tumours posterior to the equator |
Retinal fibrosis, retinal traction, retinal detachment, and vascular occlusion |
| As a consolidation therapy after chemoreduction |
| Chemotherapy |
Systemic chemotherapy |
Administration of cytotoxic drugs into the systemic circulation |
To reduce tumour volume and to increase the effectiveness of focal treatments (chemoreduction) |
Neurotoxicity, ototoxicity, bone marrow suppression, nephrotoxicity, presence of ocular blood barriers |
| As an adjuvant treatment to prevent metastasis following enucleation |
| Metastatic retinoblastoma |
| To reduce the long-term risk of secondary cancers |
| Intra-arterial chemotherapy |
Administration of anticancer drugs directly into the eye through the ophthalmic artery |
For advanced stage retinoblastoma |
Haemorrhage, stroke, loss of limb, vision loss, death |
| Recurrent tumours following previous systemic chemotherapy or plaque radiotherapy |
| Recurrent subretinal and vitreous seeds |
| Intravitreal chemotherapy |
Administration of cytotoxic drugs directly into the vitreous cavity through the pars plana |
Subretinal and vitreous seeds of tumour unresponsive to other treatments |
Transient vitreous haemorrhage, chorioretinal atrophy, and extraocular tumour spread |
| Recurrent or residual vitreous seeds |
| Enucleation |
|
Surgical removal of the intact eye |
Advanced stage retinoblastoma |
Vision loss, facial deformity |
| Retinoblastomas that are unresponsive to conservative therapies |
| To prevent metastasis |
| Presences of neovascular glaucoma, vitreous haemorrhage, cataract, corneal opacity |
