Oncologie Flashcards
Comment fonctionne la chimiothx?
Disruption of DNA synthesis at S phase (carboplatin, etoposide, 5-FU)
Inhibition of Mitosis at M phase (vincrisitine)
Mécanismes et types de radiothérapie
Mécanismes
- Direct damage of tumour DNA
- Indirect damage of DNA through ionization of H2O –> free radicals
Types :
- Teletherapy
- Brachytherapy
Ddx des eyelid epidermal tumours
Benign epidermal tumours
- Squamous Papilloma
- Seborrheic Keratosis
- Keratacanthoma
Malignant Epidermal Tumours
- Basal Cell Carcinoma
- Squamous Cell Carcinoma
Caractéristiques du BCC (types de morphologie, FdR, localisation)
Morphological types :
- Nodular
- Ulcerative
- Pigmented
- Morpheaform
- Rarement : Cystic or Multicenteric
FdR : high solar exposure
Localisation :
- Lower eyelid majoritairement
- Medial canthus (25%) : deep invasion, lacrimal obstruction, recurrence
2 types de Eyelid Sebaceous Tumors
Sebaceous adenoma
Sebaceous gland carcinoma
Caractéristiques du Sebaceous Adenoma
Lobulated mass
Commonly of Meibomiam origin
Carries NO malignant potential
Caractéristiques d’un Sebaceous Gland Carcinoma
Meibomian, Zeis or carancle origin
Circumscribed mass (mime un chalazion) or Diffuse
Intraepithelial spread (chronic conjunctivitis unilatérale)
3 types de eyelid neural tumors
Neurofibroma
Schwannoma
Merkel cell tumor
Caractéristiques du neurofibrome (¢ prolifératives, types)
Neurofibroma : Proliferation of axons, Schwann cells & endoneural fibroblasts
Types :
- Plexiform Neufibroma : Pathognomonic NF1, trends to recur
- Multiple Neurofibromata : Mostly associated with NF1
- Solitary Neurofibroma : Not associated with NF1
Signes NF1 : Lisch nodules, café au lat Patches
Ddx Eyelid Vascular Tumors
Congenital capillary hemangioma
Acquired capillary hemangioma
Cavernous hemangioma
Lymphangioma
Diffuse Angioma (Nevus Fammeus)
Vascular malformations
Hemangioendothelioma
Congenital Capillary Hemangioma : types, évolution et Tx
Types :
- Cutaneous (le plus fréquent)
- Subcutaneous
- Diffuse (rare)
- Orbital
Évolution :
- Involution 50% by fifth year, 70% by seventh year
Tx :
- PROPANOLOL
- Steroids
- Surgical
- Interferon
À quelle malformation vasculaire est associée le Sturge-Weber?
Diffuse Angioma (Nevus Fammeus)
Types de Bx pour une lésion diffuse eyelid (x2)
Incision Bx
Punch Bx
(Include adjacent normal tissu in the Bx)
Types de Bx pour une lésion circonscrite eyelid (x2)
Excision Bx
Shave Bx
Non-surgical Tx of Eyelid Tumours
Radiothérapie
Cryothérapie (for small lesion, may cause skin depigmentation)
Steroids (intra-lesional, systemic for capillary hemangioma)
Interferon alpha-2
Propanolol
Sclerosing agents
Chemotherapy
Immunotherapy (Imiquod 5% cream for BCC, BRAF inhibitors in melanoma)
Cible de l’immunothérapie utilisé pour certains mélanomes
BRAF inhibitors
Définition, indication et complications de l’orthovoltage X-Ray Radiotherapy
Orthovoltage : Type of radiation therapy
- X-rays used are strong enough to kill cancer cells but do not penetrate more than few mm beyond the surface of the skin
- Effective treatment for very superficial, small tumours (ex. skin cancer)
Indication : Malignant eyelid tumours ≤ 10 mm depth
Provides 95% tumour control
Complications :
- Loss of lashes
- Skin telangiectasia
- Dry eye/Epiphora
Most common ocular surface neoplasia
Epithelial tumors :
- Squamous Papilloma
- Conjunctival Intraepithelial Neoplasia (CIN)
- Squamous cell carcinoma
Melanocytic tumors :
- Nevus
- Melanosis (racial, PAM, subepithelial)
- Melanoma
Lymphoproliferative tumors
Vascular : lymphangioma, hemangioma
Others : pyogenic granuloma, dermoid…
Caractéristiques et Tx Conjunctival Intraepithelial Neoplasia (CIN)
Flat/Sessile mass
Translucent/gray/fleshy
Starts at the limbus → empiète sur la cornée
NO basement membrane invasion → NO metastasis
Tx :
- Surgical excision
- Interferon
- MMC (topical mitomycin C)
- 5-FU eyedrops
Caractéristique et Tx Squamous Cell Carcinoma
THE MOST common conjunctival malignancy
CIN → invades basement membrane
Arise de novo, at the limbus or fornix
Examine for local lymph nodes (if suspicious → MRI)
Tx :
- Excision + margin cryotherapy +/- PO local chemo
- If scleral invasion on UDM → Brachytherapy
Quel est the most common benign conjunctival tumour?
Nevus
Quel est la caractéristique typique des Nevus conjonctivaux?
Clear cyst are characteristic
Caractéristiques d’un Nevus a/n conjonctive
The most common benign conjunctival tumour
Early adulthood
Bulbar conjunctiva, Plica or Caruncle, very rarely Palpebral
Color : melanotic to amelanotic
Clear cyst are characteristic
Tx : periodic observation with photographs, or excision
2 types de melanosis
Complexion (racial)
Primary Acquired Melanosis (PAM)
Caractéristiques d’un complexion (racial) melanosis
Dark-skinned races
Inter-palpebral on bulbar conductive and around limbus
Malignant transformation is exceedingly RARE
NO Tx is needed
Caractéristiques d’un Primary Acquired Melanosis (PAM)
Fair-skinned
Involved any area of the conjunctiva
PAM with severe atypia → significant nuclear change → 35% develop melanoma
Tx :
- Clinically mild : observation
- Suspicious : Bx + cryothx
- Extensive : topical anti-mitotic + cryothx + excise residue
Mélanome de la conjonctive (origine, localisation, caractéristiques à l’E/P, sites de métastases, Tx)
Arise de novo, from PAM or very rarely a nevus (<7%)
Any area of the conjunctiva
Fleshy elevated, with feeder vessels
Early metastasis : lymph nodes, brain, other sites
Tx :
- Localized : excision + brachytherapy
- Extensive : exenteration
Signe caractéristique d’un tumeur lymphoproliférative (ocular surface neoplasia)
Salmon patch (all grades)
Type de ¢ le plus souvent impliqué dans tumeur lymphoproliférative (ocular surface neoplasia)
Lymphoma is mostly non-Hodgkin’s SMALL B-cell type
Caractéristiques de lymphome (ocular surface neoplasia)
Spectrum : low grade (ex. MALT) ad high grade (ex. Mantle cell)
Clinically : Salmon patch (all grades)
Lymphoma is mostly non-Hodgkin’s SMALL B-cell type
Treatment :
- Localized : excision bx + systemic staging
- Diffuse : incision bx + systemic stating
Ix pour le staging du lymphoma (ocular surface neoplasia) et CAT
Lymphoproliferative Systemic Staging
- MRI of head and neck
- Bx and pathological grading
- Whole body CT scans
- Referral to radiation/medical oncologist
Tx :
- Radiotherapy (20-40Gy)
- Chemotherapy
- Interferon
- Rituximab (Anti-CD 20 antibodies)
Caractéristiques d’un lymphangiome
Vascular Tumor
Multiple small cysts filled with clear fluid and/or blood
Eyelid involvement is mostly associated with conjunctival lymphangioma
Episodic swelling due to bouts of hemorrhage (crises d’hémorragie) and/or local infections
Associated with buccal or labial lymphangioma
NO involution with age
CAT :
- Poor response to steroids
- Observation
- CO2 laser-aided debulking
- Complete excision in selected cases
- For deeper, extensive lymphangiomas : intralesional sclerosing agents
2 type of Treatment for Conjunctival Tumors
SURGICAL excision
TOPICAL treatment for Conjunctival
SURGICAL excision of Conjunctival Tumour
SURGICAL excision
- Alcool (absolute 70%) corneal epitheliectomy
- Total tumour excision from cornea and conjunctiva
- Cryotherapy of the conjunctival margins
TOPICAL treatment of Conjunctival Tumour (Rx, indications et complications)
TOPICAL treatment for Conjunctival Tumors
- Mitomycin-C (MMC) 0,02-0,004%
- 5-Flourouracil 1% (5-FU)
- Interferon alpha 2a
Indications :
- CIN; superficial SCC = Interferon
- PAM = MMC
- Intra-epithelial spread of Sebaceous Cell carcinoma
Complications :
- MMC = Severe epithelial toxicity
- Lacrimal drainage scarring
- Resistance/Recurrence
Clinical Manifestations of Orbital Tumors (Les Ps)
Proptosis : direction, constancy, positional change
Pain : with inflammation, malignancy
Progression
Palpation : orbital rim, lacrima fossa
Pulsations : vascular fistula, NF1, meningocele
Peri-orbital changes : salmon patches, ecchymosis
Clinical classification of Orbital Tumours
Classification à partir du CT scan
- CT scan = gold standard
Lacrimal gland mass
Circumscribed orbital mass
Diffuse orbital mass
Orbital cysts
Optic nerve mass
Paediatric orbital mass
Ddx d’une lacrimal gland mass
Lymphoproliferative/chronic inflammation
Acute dacryoadenitis
Pleomorphic adenoma (le plus fréquent)
Adenoid cystic carnoma
Caractéristiques du lymphoproliferative/chronic inflammation (lacrimal gland mass)
+/- bilateral
Painless
Moulds to orbital structures
Caractéristiques de l’Acute dacryoadenitis (lacrimal gland mass)
Acute dacryoadenitis
+/- bilateral
Rapid course
Painful
Oblong swelling
Caractéristiques du Pleomorphic adenoma (lacrimal gland mass)
Pleomorphic adenoma = le plus fréquent
- Unilateral
- Slow growth
- Spherical mass
- Indents bone (ne cause pas d’érosion des os)
Caractéristiques de l’Adenoid cystic carnoma (lacrimal gland mass)
Unilateral
Rapid growth
Painful
Irregular mass
+/- bone erosion
Ddx circumscribed orbital mass
Cavernous hemangioma
Haemangiopericytoma
Neurofibrom
Schwannoma/Neurilemmona
Fibrous histiocytoma
Rare : solitary fibrous tumor, thromboses varix, ectopic meningioma
Caractéristiques Cavernous hemangioma
Most commun
Very slow growth
Progression per-grossesse
Caractéristiques Haemangiopericytoma
Injection conjonctive
Récurrence
Malignancy
Caractéristiques Neurofibrom
Solitary
Can be multiple or extensive in NF1
Caractéristiques du Schwannoma/Neurilemmona
Along a peripheral nerve
Antoni A&B
1% malignant
Caractéristiques Fibrous histiocytoma
Superonasal quadrant
Middle age
Benign or malignant
Ddx diffuse orbital mass in Adult
Lymphoproliferative/leukemia
Metastasis
Idiopathic/Granulomatous inflammation
Cellulitis/Subperiosteal abcess
Caractéristiques Lymphoproliferative/leukemia
+/- Bilateral
Painless
Slow
Caractéristiques Metastasis
+/- history of cancer
Painless
Rapid
Unilateral
Caractéristiques Idiopathic/Granulomatous inflammation
Rapid
Painful
Recurrent
Responsive to steroids
Caractéristiques Cellulitis/Subperiosteal abcess
Rapid
Painful
Fever
Motility limitation
Sinusitis
Ddx des Orbital cysts
Dermoid cyst/Teratoma
Epithelial cyst
Parasitic cyst
Hemorrhagic cyst
Sinus Mucocele
Meningocele/Encephalocele
Colobomatous cyst
Cyst inside a solid tumour
(Fluide = très bright à l’IRM)
Ddx des optic nerves tumours
Optic nerve sheath meningioma
Optic nerve glioma
Secondary (ex. RB)
Les 2 premiers sont les plus fréquents
Caractéristiques du Optic nerve sheath meningioma
Middle aged female
Minimal proptosis
Gaze evoked amaurosis
Central scotoma
Disc swelling or atrophy
Retino-choroidal shunts on the disc
Tram track sign : calcification au CT
Qu’est que le Tram track sign et à quelle pathologie est-il associé?
Tram track sign : calcification in CT scan
Optic nerve sheath meningioma
(Tram track sign: parallel thickening and enhancement around the optic nerve)
Caractéristiques du Optic nerve glioma
Slow, progressive proptosis in the first 2 decades
+/- Vision loss
+/- Involuntary eye mvt
Chronic dis swelling
Retinal vascular turtuosity
50% have NF1
Tx :
- Observation
- Chemotherapy
- Radiothx
- Surgery (optic canal invasion)
Ddx Paediatric orbital Mass
Dermoid/Teratoma
Capillary Haemangioma
Rhabdomyosarcoma (le plus fréquent)
Lymphangioma
Orbital Cellulitis
Optic nerve glioma
Metastatic (Neuroblastoma, Ewing’s, Wilms’…)
Leukemic metastasis
Fibrous dysplasia (Albright’s syndrome)
Histiocytosis (Rosai-Dorfman syndrome)
Présentation typique et Tx du Rhabdomyosarcome
Typical presentation
- Rapid (orbital cellulitis-like) proptosis
- First 2 decades of life
Tx
- Bx then
- Radiothx + Chemothx (excellent response)
Clinical signs suspicious of malignant transformation of an iris nevus?
Documented rapid growth
Increasing tumour vascularity
Satellite lesions +/- pigment dispersion
Secondary glaucoma
Incidence et Tx du Iris Melanoma
Incidence : 5% of all uveal melanoma
Treatment modalities
- Iridocyclectomy
- Brachytherapy
- Proton beam radiotherapy
- Enucleation
Caractéristiques d’un Ciliary Body Melanoma (incidence, clinical clues)
10% of all uveal melanoma
85% asx → Delayed Dx (because of their hidden position)
Clinical Clues :
- Sentinel vessels
- Iris bulge
- Sector cataract
- Pigmented nodule at iris root
- Episceral pigmentation
Anterior Segment Ultrasonography (UBM versus B-scan)
Ultrasound Biomicroscopy (UBM)
- Measures iris and ciliary body tumour < 4 mm
- Ciliary body involvement in peripheral tumours
- Circumferential extension
- Internal echogenicity (cysts, necrosis…)
B-scan
- Anterior tumours > 4 mm thickness
- Less accurate, less resolution
Incidence et risque de transformation maligne d’un choroidal nevus
Incidence : 5-10% of the population
The risk of malignant transformation : 1: 8000 of typical naevi
Imaging of choroidal melanoma
A-scan :
- Low internal reflectivity
- Angle-kappa (Decrescendo pattern)
B-scan :
- Acoustic hollowness
- Choroidal Excavation
- +/- Orbital Shadowing
Posterior Segment Ultrasonography :
- Measures apical height
- Tumour profile (dome, mushroom, flat…)
- Presence of sub retinal fluid
- Differentiates melanoma from other choroidal masses (in case of opaque media, non-pigmented tumour…)
Fluorescein Angiography :
- Dual-circulation sign
- Subretinal haemorrhage
- Hot Spots sign
- Delineation fo tumour margins
Caractéristique Choroidal Melanoma (demographics and most common sites for metastasis)
Demographics :
- Peaks 55-70 ans
- No sex predilection
- Fair-skinned individuals
Most common sites for metastasis :
- Liver > 90%
- Lung
- Subcutaneous, GIT, renal…
Clinical Risk Factors for Growth Intraocular Melanotic Lesions (To Find Small Ocular Melanoma Ultimately without Delay!)
To Find Small Ocular Melanoma Ultimately without Delay!
Thickness > 2 mm
Subretinal Fluid
Symptoms
Orange pigments
Margin near optic disc
Ultrasound hollowness
Absence of drusens
Treatment of Uveal Melanoma
Radiation therapy
- Brachytherapy
- Teletherapy
Thermotherapy/PDT
Surgical Resection
Enucleation
No effective : Chemotherapy, Cryotherapy, Immunotherapy
Isotopes de la brachytherapy
Ruthenium 106
Iodine 125
Autres :
Palladium 103
Iridium 192
Strontium 90
Gold 198
Cobalt 60
Complications/ES de la radiothérapie
Cataractes
Glaucome néovx
Radiation retinopathy
Radiation papillopathy
Indications de la trans pupillary thermotherapy (TTT)
Mechanism is unknown
Indications :
Tumour edge recurrence post radiotherapy
Adjuvant treatment with decentred plaques
Sandwich Technique with Ruthenium plaques
Caractéristiques d’un Optic Disc Melanocytoma
Melanotic lesion
Histology :
- « Magnocellular Nevus »
- Plump Polyhedral cells with numerous melanosomes
Px :
- Subtle growth in 10% of cases
- Enlarged blind spot
- Arcuate field defect
- CRVO/CRAO
- Melanoma transformation : 2% of cases
Caractéristiques d’un CHRPE (Congenital Hypertrophy of The Retinal Pigment Epithelium)
Melanotic lesion
Anomalie congénitale qui arrive in early age
Pigment souvent darker
Unique ou multiple
Lésion habituellement bien délimitée
No risks
Slow growth in 50% of cases
Small scotoma
Gardner syndrome :
- AD adenomatous colonic polyposis
- CHRPE-like lesions : lésions qui ressemblent plus à un poisson, bear tracks (lorsque mutiple lesions)
- Extracolonic benign tumours (osteoma, fibroma…)
Caractéristiques Choroidal Metastases
Amelanotic Lesion
25% of cases with NO history of primary
Most common site of origin : lung cancer, breast cancer, GU cancers
Most common presentation : unilateral, unifocal and amelanotic lesion
CAT :
- Chemotherapy of the primary cancer
- Low dose external radiotherapy
- Plaque radiotherapy for a recurrent unifocal metastasis
Choroidal Metastasis versus Amelanotic Melanoma (surface, growth rate, echogenecity, profile, intrinsic vessels)
Choroidal METASTASIS
- Surface : Leopard skin
- Growth rate : Significantly faster
- Echogenecity : Medium-high
- Profile : Irregular, diffuse, dome
- Intrinsic vessels : Absent (avasculaire)
Amelanotic MELANOMA
- Surface : +/- subtle intrinsic pigmentation
- Growth rate : Relatively slower
- Echogenecity : Medium-low
- Profile : Dome, diffuse, collar-button
- Intrinsic vessels : +/- Present
Caractéristiques intraocular lymphoma
Non-Hodgkin’s LARGE B-cell lymphoma
Corticosteroids-resistant vitritis
+/- patchy retinal infiltration
80% of PIOL will develop PCNSL
20% of PCNSL will develop PIOL
PIOL : Primary intraocular lymphoma
PCNSL : Primary CNS lymphoma
Caractéristiques Uveal +/- Adnexal Lymphoma
May have intraocular and extra-ocular components
Non-Hodgkin’s SMALL B-cell lymphoma (Mostly MALT)
Choroidal unifocal or multifocal infiltrates
Ultrasound : uveal thickening +/- extra ocular thickening
OCT : sea sick appearance
Tx : ocular irradiation
Px depends on lymphoma type :
- MALT & Follicular lymphoma : ocular, good Px
- Mantle cell & DLBC lymphoma : systemic, poor Px
Caractéristiques d’un Choroidal Granuloma
Irregular margins with clumps of cells
Satellites +/- vitiritis +/- anterior uveitis
Etiology : TB, sarcoïdose, idiopathique…
Management :
- Posterior uveitis work-up
- If negative : Bx (pour démontrer que c’est idiopathique, et non pas une néo)
Caractéristique circumscribed choroidal haemangioma
DD from uveal melanoma
- Orange color
- US : solid, high internal reflectivity
- FA : intense fluorescence (mid and late phases)
CAT:
- Observation (peripheral, dormant, no fluid)
- PDT
- Radiotherapy
- External irradiation
Pathologie associée à un diffuse choroidal haemangioma
Sturge-Weber Syndrome
Risks : glaucoma, neurological sx
CAT of diffuse choroidal haemagioma
- Low dose external irradiation (20-30 Gys)
- Photodynamic therapy
Ddx lésion intraoculaire
Melanotic Lesions
a. Iris Nevus
b. Iris Melanoma
c. Ciliary Body Melanoma
d. Iris Epithelial Cyst
e. Choroidal Nevus
f. Choroidal Melanoma
g. Other Melanotic Lesions : Optic Disc Melanocytoma, Congenital Hypertrophy of the Retinal Pigment Epithelium (CHRPE)
Amelanotic Lesions
a. Choroidal Metastases
b. Amelanotic choroidal melanoma
c. Intraocular lymphoma
d. Choroidal granuloma
Vascular Lesions
a. Circumscribed Choroidal Haemangioma
b. Diffuse Choroidal Haemangioma
c. Retinal Capillary Haemangioblastoma
Calcific Lesions
a. Choroidal Osteoma
b. Retinal Astrocytic Hamartoma
5. Retinoblastoma
Complication of retinal hemangioblastoma
Exudative retinal detachment (grand risque de décollement rétine 2nd vx)
CAT:
- Observation
- Photocoagulation, PDT
- Cryothx
- Plaque Radiotherapy
Caractéristiques Choroidal Ostéome (typical patient, complications, CAT, Px)
Typical patient :
- Young female
- Unilateral
- Asx or +/- metamorphopsia (si présent sur la macula)
Complications :
- SRNVM (subretinal neovascular membrane)
- Central vision loss or field defects
CAT of SRNVM in osteoma :
- PDT
- Anti-angiogenic injections
- Laser photocoagulation less efficient (RPE atrophy)
Px : gradual loss of vision from retinal atrophy or SRNVM
Caractéristiques Astrocytic Hamartoma
Cell of origin : undifferentiated neuroglial cells
Morphologic Types :
1. Round semi translucent lesion
2. Calcified mulberry lesion
3. Mixed, translucent with calcific center
Pathologie associée à Astrocytic Hamartoma
Sclérose tubéreuse
- Sporadic or AD chromosome 9q
- 40% Astrocytic Hamartoma
- Mental retardation, epilepsy, skin lesions
Incidence et 2 sx les plus fréquents du Retinoblastoma
Incidence of 1 : 12 000-18 000 live births
Sx :
- Leukocoria (55%)
- Strabismus (25%)
Obstetric Ultrasonography : large RB at 33 weeks of gestation
Mutation et chromosome impliqué dans le Retinoblastoma
Chromosome 13
Mutation of the 2 alleles (AD) of the tumour-suppressor gene RB1
- « Knudson two-hit hypothesis »
Acquisition du Retinoblastoma
SPORADIC (No family Hx)
- Non-Heritable (60%) : two somatic mutations in a progenitor retina cell → lésion unilaterale, unifocale
- Heritable (30%) : Germline mutation started in early embryogenesis of the proband → bilateral/multifocal
FAMILIAL (10%) : germline mutation inherited an affected parent → bilateral/multifocal
Grouping and staging of Retinoblastoma
Group A :
- Tumors < 3 mm
- >1 Disc Diameter (DD) from optic disc
- > 2 DD from fovea
Group B :
- Tumors < 3 mm
- Any location
- No vitreous seeds
- Subretinal fluid (SRF) within 5 mm
Group C :
- Vitreous/SRF seeds within 3 mm from tumour
- SRF within one quadrant
Group D :
- Diffuse large vitreous/subretinal seeds > 3 mm from tumor
- SRF > one quadrant
Group E :
- Anterior segment
- NVG
- Massive Hg
- Diffuse infiltrating
Vitreous seeds : tumor cells floating within the vitreous cavity
Initial Assessment for Retinoblastoma
Fx Hx and Pedigree drawing
IRM > CT tête et orbites
Examination under anesthesia (EUA) with bilateral Retcam imaging
B-scan and UBM
Fluorescein angiography
Blood sample for gene mutation testing
Group E or orbital tumor : CSF cytology
Treatment planning according to IIRC and TNM staging
Ddx d’une leukocoria
Cataract
Uveitis/Toxocariasis
PHPV (persistance système vasculaire hyaloïde)
Astrocytoma (from endophytic RB)
ROP
Retinal dysplasia/coloboma
Coat’s disease
Différencier exophytic RB from Coat’s disease :
- Yellowish fundus color
- Unilateral
- Male
- Course of retinal vessels
Tx of Retinoblastoma
Systemic chemotherapy
- Chemoreduction followed by focal therapy for bilateral RB (group B-D)
- Vincristine + Etoposide + Carboplatin
- Toxicity : ototoxicity, nephrotoxicity, myelodysplasia, acute myeloid leukemia (AML)
Focal therapy
- Focal laser : Group A-B, posterior location, minimal SRF
- Cryothx : peripheral tumours = prior to chemo
- Brachythx : post chemo, unifocal, medium
External Beam Radiothx
- Failed to Chemothx + Focal Thx in an eye with vision potentials
- Risks : secondary cancer (38% at 50 ys), orbital bone deformities (avoid be4 age of 12 months)
Enucleation
Indications :
- Any Group E tumor
- Advanced Group D tumor (if other eye has vision potential)
- Recurrent : if other Tx failed
- Evidence of optic nerve, anterior segment or extraocular invasion
Intra-Arterial Chemothx (IAC)
- Femoral artery catheterization
- Melphalan, Topotecan, Carboplain…
- Variable control rates
- Advantages : fewer systemic side effects than IV chemo
- Disadvantages : specific serious complications (sectoral choroidal occlusive vasculopathy, retinal arteriolar embolization, cataractogenic radiation dose from fluoroscopy)
Intravitreal chemothx
- Intravitreal Melphalan
- Best current Tx for VITREOUS SEEDS
- Cryo at injection site be4 withdrawing
- Toxicity : salt and pepper fundus, reduced ERG response
