The Evolution of Pediatric Retinoblastoma Treatment

According to the Memorial Sloan Kettering Center, about 350 children are diagnosed with pediatric retinoblastoma every year in the US. While this pediatric eye cancer can be scary, treatment for retinoblastoma has advanced so much that about 95 percent of patients diagnosed with it are cured.

This evolution is extraordinary, considering that the disease used to be considered a death sentence 100 years ago.

First Retinoblastoma Diagnosis

The very first retinoblastoma diagnosis was made by James Waldrop in 1809. At that time, he suggested enucleation, or the removal of the eye, as the appropriate treatment for the disease. Throughout the 1800s and early 1900s, enucleation continued to be the sole treatment for retinoblastoma. Most patients did not survive even after enucleation, however, as the cancer was usually not diagnosed until later stages.

By 1900, the survival rate for retinoblastoma was about five percent.

Introduction of Radiation

In 1903, the first successful treatment of retinoblastoma with radiation was announced. From that time until the 1940s, the use of radiation in treatment for retinoblastoma became more and more widespread and continued to improve until it was a standard treatment for the cancer.

Radiation still continues to be used as a treatment for retinoblastoma today, with the condition being cured by radiation alone in some cases.

Preservation of VisionRetinoblastoma Treatment

While radiation improved survival rates for retinoblastoma dramatically, patients did not begin retaining their vision until the 1930s. At this time, radioactive plaques were introduced that worked to deliver the radiation to only a portion of the eye so that the rest of the eye could be saved. Treatment focus changed to limit enucleation to extreme cases, with an emphasis on saving patients’ eyes and vision whenever possible.

Cryotherapy and Photocoagulation

Photocoagulation was introduced as a retinoblastoma treatment in the 1950s, giving doctors an alternative that avoided some of the risks of radiation and enucleation.

Even greater numbers of patients began retaining their eyesight with the use of this white light that was able to carefully destroy very small amounts of tissue. Cryotherapy, or freezing tissue to control the cell dead of cancer tissue, was introduced as a treatment method in the 1960s.

Chemotherapy for Retinoblastoma

Chemotherapy was first used to treat retinoblastoma in the 1950s, but it was in the late 1980s and early 1990s that doctors began prescribing it more widely for use in retinoblastoma cases.

This is because with retinoblastoma rates moving towards 90 percent, doctors were able to do more follow-up appointments than ever before and began to realize that secondary tumors were very common in patients that had been treated using radiation.

Chemotherapy cannot generally be used as a primary retinoblastoma treatment, but sometimes works as a supportive treatment for retinoblastoma.

Retinoblastoma Treatment Today

Chemotherapy has shown to be an effective treatment for retinoblastoma, but systemic chemotherapy often makes patients ill and sometimes increases the risks of secondary tumors, especially when combined with radiation. The introduction of superselective chemotherapy within the past decade now allows doctors to deliver a high dose of chemotherapy directly to tumors without harming other body tissues, further improving patient prognosis.

The outlook continues to grow and prognosis is expected to further improve as retinoblastoma treatment continues to evolve.