FOCAL TREATMENTS Focal treatment is the term used to describe direct treatments to the eye(s) that try to kill or shrink the size of the tumor. These treatments can be used alone or in conjunction with other treatments. There are several different types of focal treatments including: cryotherapy (the use of extreme cold to destroy cancer cells), laser therapy (the use of a direct source of heat to the pupil and surrounding vasculature to destroy the tumor cells) and thermotherapy (similar to laser therapy but uses a lower temperature infrared laser). Other therapies that can be administered focally include chemotherapy that will be injected directly into different areas of the eye to attack cancer cells that may have spread. These focal treatments usually are performed during the exam under anesthesia (EUA) when the child is asleep. After the procedure, your child may complain of some mild pain or have local swelling or redness of the treated eye. CHEMOTHERAPY Chemotherapy is treatment with medications that are known to kill retinoblastoma tumor cells throughout the body. There are many different types of chemotherapy drugs that can be given. Some drugs can be administered alone, and others are given in combination with other chemotherapy drugs. Each drug kills the cancer cells in a different way which is why some of these drugs are used together. There are also different ways to administer chemotherapy. The type of chemotherapy drugs that are used and the way they are administered depends on the stage of the retinoblastoma disease and whether it has traveled beyond the original site in the eye. The pediatric oncologist (cancer doctor) will decide the most effective chemotherapy agents to use, the schedule for the drugs Systemic chemotherapy which can be given by mouth, through a vein or a CVAD. Chemotherapy medications used for retinoblastoma are usually given through a vein or a CVAD. The oncologist will guide you as to which type of access is most appropriate for the treatment planned for your child. Systemic chemotherapy can be used alone or in combination with various focal therapies. OAC (Ophthalmic Artery Chemosurgery) is another way that chemotherapy can be given; this may also be referred to as IAC (intra-arterial chemotherapy). Chemotherapy is administered through an artery that leads to the ophthalmologic artery so that the chemotherapy is delivered directly to the tumor in the eye. This treatment is done under anesthesia and can only be administered at certain retinoblastoma specialty centers. Intrathecal chemotherapy is administered directly into the cerebrospinal fluid (CSF) if the retinoblastoma cells have spread there. Chemotherapy can also be administered directly into certain areas of the eye. This is done while the child is receiving anesthesia. and the length of time needed to treat your child. The different types of chemotherapy include: The chemotherapy plan for your child will be carefully discussed with you. The oncologist and your treatment team will explain the reason why the particular treatment was chosen as well as potential side effects and their management.
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Association of Pediatric Hematology/Oncology Nurses (APHON)
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