[New strategies in the management of retinoblastoma].
It was rare that a child survived retinoblastoma at the beginning of the twentieth century. Today the survival rate is in the order of 95% in reference centers, with new strategies improving prognosis step by step. Systematic enucleation used to be the starting point of any true and structured management, until the advent of radiotherapy made it possible not only to save lives but also to retain some useful vision. Early diagnosis has enabled focal therapies such as photocoagulation, cryocoagulation, and radioactive applicators to open up a new era of targeted tumor treatment. However, the onset of nonocular tumors secondary to radiotherapy, the resistance of certain tumors to irradiation, and unsightly cosmetic consequences all justify research into alternative therapeutic strategies. New types of chemotherapy have shown spectacular results and are currently under study: chemoreduction to make large tumors more manageable and enable less aggressive treatment of tumors located in delicate sites, thermochemotherapy using the effect of heat on plasma membrane permeability to antimitotics, and chemotherapy associated with cyclosporine to reduce the multidrug resistance of certain tumors. The aim is to avoid primary enucleation and external beam radiation as far as possible. The future may lie in local chemotherapy, hyperthermia, and dynamic phototherapy, accelerated proton beam radiotherapy also has promising prospects.
Balmer
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Hôpital Ophtalmique Jules Gonin, Service Universitaire d'Ophtalmologie, 15, Avenue de France, CH 1004 Lausanne, France. aubin.balmer@bluewin.ch
Munier
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F
Zografos
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D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage / Q000627:therapeutic use; D005047:Etoposide / Q000008:administration & dosage / Q000627:therapeutic use; D015353:Eye Enucleation; D005137:Eye, Artificial; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005544:Forecasting; D015316:Genetic Therapy; D006801:Humans; D006979:Hyperthermia, Induced; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020360:Neoadjuvant Therapy; D019572:Retinal Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D012175:Retinoblastoma / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D013997:Time Factors
D000970:Antineoplastic Agents; D000972:Antineoplastic Agents, Phytogenic; D005047:Etoposide; D016190:Carboplatin
Nouvelles stratégies dans le traitement du rétinoblastome.