A 2-year-old child is brought with leukocoria. Retinoblastoma is confirmed. Ultrasound shows calcification; MRI shows no optic nerve enhancement. International Classification of Retinoblastoma (ICRB) Group D is diagnosed in the right eye (the only eye with disease). According to current management protocols, the preferred treatment is:
- A Intra-arterial chemotherapy (ophthalmic artery chemosurgery) or systemic chemotherapy ✓
- B External beam radiotherapy as first-line treatment
- C Enucleation with immediate prosthesis fitting
- D Transpupillary thermotherapy alone
Correct answer: A. Intra-arterial chemotherapy (ophthalmic artery chemosurgery) or systemic chemotherapy
Explanation
ICRB Group D denotes extensive vitreous or subretinal seeding threatening visual prognosis but globe salvage is still attempted. The current preferred approach is intra-arterial chemotherapy (IAC/ophthalmic artery chemosurgery with melphalan ± topotecan) or systemic chemotherapy (carboplatin-vincristine-etoposide) followed by focal consolidation (cryotherapy, thermotherapy). External beam radiation is avoided due to long-term risks (second malignancies in heritable RB, facial bone hypoplasia). Enucleation is reserved for Group E or failed salvage attempts.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.