Chemotherapy is the name for drug treatment for cancer.
In the treatment of Rb these drugs are given intravenously (into the vein) on a three to four-weekly cycle. Chemotherapy is often used in the first stage of treatment for patients with bilateral retinoblastoma and can be used for both small and large tumours.
It is also sometimes used for unilateral retinoblastoma, but only in situations where there is a good chance of preserving useful vision in the affected eye. Between four and six cycles of chemotherapy are usually used and local therapy (laser, cryotherapy or radioactive plaque) can be introduced once the tumour has shrunk.
Chemotherapy may also be required after an eye has been removed by surgery (enucleation), if there are signs that the tumour was involving the nerve, the deeper layers of the eye or the front chamber of the eye. In this situation usually only four cycles will be needed.
Children with a known family history of retinoblastoma receive regular screening at one of the Rb centres from birth and are therefore tend to be diagnosed at a younger age. If tumours are found, they are more likely to be relatively small. For such children, a combination of local therapy (cryotherapy or laser) with or without the addition of chemotherapy is usually as treatment.
When chemotherapy is recommended, the child will be under the care of a paediatric oncologist (children’s cancer doctor), who specialises in the drug treatment of cancer in children. Chemotherapy is given via a central intravenous line, and this will stay in for the duration of the chemotherapy. The nursing staff on the children’s cancer ward will teach the parents how to look after the central line.
Chemotherapy is given at the nearest children’s cancer centre and arrangements will be made for the child to be seen locally in between cycles of chemotherapy or if the child is unwell.
Possible side-effects of chemotherapy
Chemotherapy can have a number of short term side-effects, including:
- nausea and vomiting, which can be treated with powerful anti-sickness drugs,
- increased susceptibility to infection, which may require treatment in hospital with antibiotics,
- tendency to bruise easily,
- thinning or loss of hair, which will regrow after completion of the treatment.
In addition, there is no evidence that fertility is impaired by the drugs used in the first line chemotherapy treatment of retinoblastoma.
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