Jan. 07, 2022
Pediatric retinoblastoma affects about 6,000 children each year around the world according to the American Association for Pediatric Ophthalmology and Strabismus. This tumor originates in the retina and typically occurs in children under 5 years of age.
While many children are screened with a red reflex test, Lauren A. Dalvin, M.D., an ophthalmologist at Mayo Clinic in Rochester, Minnesota, points out that the tumor is commonly noticed by a patient's family members. Good communication with guardians, then, is key not only in diagnosing retinoblastoma but throughout the treatment process as well.
Comprehensive data-driven treatment plans
Dr. Dalvin is Mayo Clinic Children's Center's first full-time ocular oncologist and one of the only such physicians in the Midwest region. She has extensive research experience in the treatment of retinoblastoma. Dr. Dalvin has authored book chapters and many peer-reviewed journals, including studies published in Ophthalmology in 2018, Ocular Oncology and Pathology in 2019 and the Journal of Pediatric Ophthalmology and Strabismus in 2020. Dr. Dalvin also collaborated on an international consensus statement on the treatment of retinoblastoma, published in the Indian Journal of Ophthalmology in 2020.
Dr. Dalvin's clinical and research experience have helped advance treatment of retinoblastoma at Mayo Clinic Children's Center. While each case is unique, and ultimately eradicating the patient's cancer is the primary goal, physicians at Mayo Clinic have found success using intra-arterial chemotherapy with intravitreal chemotherapy.
"The combination has really helped us save more eyes than we've been able to in the past," said Dr. Dalvin. She explains that even with the most advanced category of retinoblastoma, physicians at Mayo Clinic Children's Center can save the eye in almost half of the patients treated. Before moving to this combination therapy, that number was approximately 20%.
While there was some hesitancy to this approach in the U.S. initially due to the small size of the blood vessels involved, Dr. Dalvin, working with Dr. Shields at Wills Eye Hospital in Philadelphia, found that the only predictive feature of vascular complications with this treatment was the experience of the treating physician. Mayo Clinic Children's Center's retinoblastoma team includes a very skilled and experienced neurointerventional radiologist.
In addition to data-driven treatments, Dr. Dalvin has created a prospective eye tumor dataset to help illuminate further advances in the field. She tracks outcomes for all patients who are willing to be involved with the hopes of identifying patterns and eventually creating predictions based off the database.
The pediatric retinoblastoma experience
Treatment for pediatric retinoblastoma has unique advantages when done within a major hospital such as Mayo Clinic. A multidisciplinary approach with in-house access to other specialties helps physicians provide highly individualized, highly complex care.
"We can offer these kids complete care all in one setting," said Dr. Dalvin. "There's so much we can accomplish even just under one anesthesia setting."
For example, a patient can receive an examination and intravitreal chemotherapy administered by the neurointerventional radiology team, an MRI to rule out a pineal tumor, and intra-arterial chemotherapy administered by the neurointerventional radiology team under a single anesthesia session. Patients can also receive maximally active medications with direct access to Mayo Clinic's onsite compound pharmacy.
Treating pediatric retinoblastoma in a hospital setting also provides direct access to surgical, lab, pediatric oncology and social work teams that communicate with one another. These partnerships maximize screenings and have even led to the development of adapters for ocular equipment to better tailor to the needs of pediatric patients.
Clear communication supports the process
Dr. Dalvin not only suggests clear communication in the process of diagnosing retinoblastoma, but throughout the entire treatment process as well. Each case is unique and individualized care is the best approach.
"It's really easy, because we've gotten so much better at saving eyes, to jump forward and think about vision as our primary goal," said Dr. Dalvin. "Even with this progress, there are still times when the safest thing for the child's life is to remove the eye."
She ensures clear communication with parents so that all understand her primary goal of killing the cancer. Then the care team can focus on saving the eye followed by conversations about maximizing vision.
For more information
Dalvin L, et al. Ophthalmic vascular events after primary unilateral intra-arterial chemotherapy for retinoblastoma in early and recent eras. Ophthalmology. 2018;125:1803.
Dalvin L, et al. Primary intra-arterial chemotherapy for retinoblastoma in the intravitreal chemotherapy era: Five years of experience. Ocular Oncology and Pathology. 2019;5:139.
Dalvin L, et al. Risk factors for tumor recurrence following primary intravenous chemotherapy (chemoreduction) for retinoblastoma in 869 eyes of 551 patients. Journal of Pediatric Ophthalmology and Strabismus. 2020;57:224.
Ancona-Lezama D, et al. Modern treatment of retinoblastoma: A 2020 review. Indian Journal of Ophthalmology. 2020;68:2356.
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