The traditional priorities in retinoblastoma treatment are guided by a simple trinity: first, save the life; second, preserve the eye while not placing the child at undue risk; and third, preserve useful vision. Because globe-preserving therapy has become more effective, particularly with intra-arterial chemotherapy (IAC), we have appropriately moved toward attempting to save ever more advanced eyes.
Quick Take
Retinoblastoma management is increasingly shifting toward aggressive globe preservation, driven by the improved efficacy of intra-arterial chemotherapy (IAC). While the clinical hierarchy remains focused on saving life first, the ability to salvage more advanced eyes is challenging traditional treatment thresholds.
Why It Matters
For years, the standard for advanced retinoblastoma was enucleation to ensure patient survival. The rise of IAC has created a paradigm shift where clinicians must now navigate the delicate balance between attempting to save an eye and the potential risk of systemic spread. This evolution reflects a broader trend in ocular oncology where technological advancements are allowing for more conservative management without necessarily compromising the primary goal of life preservation.
Key Details
Practice Implications
Clinicians should evaluate advanced retinoblastoma cases for globe-salvage potential using IAC, but must maintain a strict adherence to the hierarchy of care that prioritizes life over the eye. Careful patient selection and rigorous monitoring are required when attempting to save advanced eyes to ensure that the window for life-saving enucleation is not missed.
Who's Affected
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