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. There are five types of focal treatments: cryotherapy (freezing), laser photocoagulation (clotting using laser light), thermotherapy (laser-created heat), radioactive plaque (radiation applied directly to the eye), and subconjunctival chemotherapy (direct injection of chemotherapy into the eye). 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 tumor cells throughout the body. Although several chemotherapy medica- tions are known to be effective in the treatment of retinoblastoma, chemotherapy alone cannot control this disease. Each of the medications kills the cancer cells in a different way, which is why certain chemotherapy medications are used together and on a particular schedule. For reti- noblastoma, all chemotherapy drugs, other than subconjunctival treatments, are given through a vein or VAD. Your child’s doctor will discuss with you the specific chemotherapy treatments recommended for your child and any potential side effects.
Chemotherapy usually is given to children with multifocal unilateral (multiple tumors in one eye) and bilat- eral retinoblastoma because it helps shrink the tumors and aids focal eye treatments. It also is beneficial for children with advanced disease within the eye(s) or metastases, and those who are at higher risk of having the retinoblastoma spread. RADIATION Radiation therapy also is used in the treatment of retinoblastoma, usually in combination with other thera- pies or after other therapies have failed. There are two types of radiation therapy used for retinoblastoma: brachytherapy and external beam radiation therapy. Brachytherapy is a plaque (special radioactive patch) that is placed directly around the affected area of the eye. It is sewn to the skin that covers the eye while the child is under general anesthesia in the operating room. Side effects may include pain, swelling, and redness of the treated eye. The plaque remains in place for 3–5 days, depending on the dose of radiation that needs to be delivered, and then is removed while the child is under general anesthesia in the operating room. This form of treatment delivers concentrated radiation therapy only to the tumor without affecting the rest of the eye or the eye socket (bone). The child remains in the hospital during this process. External beam radiation therapy is rarely given to a child younger than 1 year of age, but it may be used in older children. It consists of a very precise measured amount of radiation that is delivered to the af- fected orbit(s) every day over a period of 4–6 weeks. The length of time varies depending on the dose
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