Retinoblastoma Guideline

Thai Pediatric Oncology Group
ชมรมโรคมะเร็งเด็ก
Retinoblastoma
Staging system
International Classification System for Intraocular Retinoblastoma
(Murphree AL: Intraocular retinoblastoma: the case for a new group classification. Ophthalmol Clin North
Am 2005; 18:41-53.)
Group A: Small intraretinal tumors away from foveola and disc

• All tumors are 3 mm or smaller in greatest dimension, confined to the retina and
• All tumors are located further than 3 mm from the foveola and 1.5 mm from the optic disk
Group B: All remaining discrete tumors confined to the retina
• All other tumors confined to the retina not in Group A
• Tumor associated with subretinal fluid less than 3 mm form the tumor with no subretinal seeding
Group C: Discrete local disease with minimal subretinal or vitreous seeding
• Tumors are discrete
• Subretinal fluid, present or past, without seeding involving one fourth of the retina
• Local fine vitreous seeding may be present close to discrete tumor
• Local subretinal seeding less than 3 mm (2 disk diameters) from the tumor
Group D: Diffuse disease with significant vitreous or subretinal seeding
• Tumors may be massive or diffuse
• Subretinal fluid present or past without seeding, involving up to total retinal detachment
• Diffuse or massive vitreous disease may include “greasy” seeds or avascular tumor masses
• Diffuse subretinal seeding may include plaques or tumor nodules
Group E: Presence of any one or more of these poor prognostic features
• Tumor touching the lens
• Tumor anterior to the anterior vitreous face involving ciliary body or anterior segment
• Diffuse infiltrating retinoblastoma
• Neovascular glaucoma
• Opaque media from hemorrhage
• Tumor necrosis with aseptic orbital cellulites
• Phthisis bulbi
Retinoblastoma: Staging system 210

Pathologic classification (pTNM)

(From American Joint Committee on Cancer Retinoblastoma. Manual for staging of cancer. 7th ed, 2010)
Primary Tumour (pT)
pTX: Primary Tumour cannot be assessed.
pT0: No evidence of primary tumour
pT1: Tumour confined to the eye with no optic nerve or choroidal invasion.
pT2: Tumour with minimal optic nerve and / or choroidal invasion:
pT2a: Tumour superficially invades optic nerve head but does not extend past lamina
cribrosa, or tumour exhibits focal choroidal invasion.
pT2b: Tumour superficially invades optic nerve head but does not extend past lamina
cribrosa and tumour exhibits focal choroidal invasion.
pT3: Tumour with significant optic nerve and / or choroidal invasion:
pT3a: Tumour invades optic nerve past lamina cribrosa but not to surgical resection
line, or tumour exhibits massive choroidal invasion.
pT3b: Tumour invades optic nerve past lamina cribrosa but not to surgical resection
line and exhibits massive choroidal invasion.
pT4: Tumour invades optic nerve to surgical resection line or exhibits extra-ocular
extension elsewhere.
pT4a: Tumour invades optic nerve to resection line, but no extra-ocular
extension identified.
pT4b: Tumour invades optic nerve to resection line, and extra-ocular
extension identified.
Regional Lymph Nodes (pN)
pNX: Regional lymph nodes cannot be assessed.
pN0: No regional lymph node metastasis
pN1: Regional lymph node involvement (preauricular, cervical)
pN2: Distant lymph node involvement
Metastasis (pM)
pMX: Presence of metastasis cannot be assessed.
pM0: No distant metastasis
pM1: Metastasis to sites other than Central Nervous System
pM1a: Single lesion
pM1b: Multiple lesions
pM1c: CNS metastasis
pM1d: Discrete masses without leptomeningeal and / or CSF involvement
pM1e: Leptomeningeal and / or CSF involvement
Final Staging ___________________________________________
Retinoblastoma: Pathologic classification (pTNM) 211

Investigations
Examination -Examination under anesthesia by ophthalmologist
-Audiology evaluation (hearing test) if systemic carboplatin is considered
Imaging studies -CT or MRI scan of brain and orbit Æshould include the pineal gland to
exclude trilateral retinoblastoma ( prefer MRI to avoid radiation exposure)
Laboratory evaluations -CBC
-BUN, Cr, electrolytes, Ca, Mg, P, LFT
-Calculated creatinine clearance
-Urine analysis
Diagnostic studies -Lumbar puncture only when there is radiographic or clinical suspicion of
CNS disease ie. optic nerve involvement or ≥ stage pT2
-Bone scan only with bone pain or other extraocular disease
-Bone marrow aspiration and biopsy only when there is abnormal blood
counts (without alternative explanation) or other extraocular disease
-Pathologic evaluation if enucleation is performed.
Indications of enucleation
1. Large tumor >50% of globe volume (ICRB group E, + D)
2. No potential for visions
3. Painful eyes
4. Optic nerve involvement
Laser photocoagulation and cryotherapy
For ICRB Group A: repeat every 3-4 weeks until evidence of tumor regression and inactivity (indirect
fundoscopy showing flat scar (or type IV regression pattern) along with the absence of new tumor foci,
evidence of tumor recurrence, or evidence of subretinal fluid, subretinal seeds, or vitreous seeds).
External beam radiation therapy (EBRT: lens sparing EBRT vs whole eye EBRT)
Standard dose is 40-45 Gy, preferably conformal, stereotactic, proton-beam or intensity-modulated
radiotherapy, and delayed to after 1 year of age with use of systemic adjuvant chemotherapy to avoid risk of
secondary malignancy
Family screening
Evaluation Schedule
Eye examination for -Parents and siblings of patients should have screening ophthalmic
parents and siblings examinations to exclude an unknown familial disease.
-Siblings should be under close surveillance until age 3 to 5 years (every 1-2
months during the first year, then every 2 months during the second year,
then every 4-6 months during the third year, then once or twice a year until
age 5, after that follow as general population ) or until confirmed not to have
a genetic mutation.
Retinoblastoma: Investigations 212

Summary treatment strategy based on laterality and retinoblastoma grouping

International
Classification
Unilateral Bilateral*
of
Retinoblastoma
A Laser or cryotherapy Laser or cryotherapy
B CV or plaque + Laser or cryotherapy CV + Laser or cryotherapy
C CEV or plaque + Laser or cryotherapy CEV + Laser or cryotherapy
D Enucleation or CEV + SCC + Laser or CEV + SCC + Laser or cryotherapy
cryotherapy
E Enucleation Enucleation but if both eyes equally
advanced then CEC + SCC + Laser
or cryotherapy + low – dose EBRT
* Treatment in bilateral cases is usually based on the most advanced eye, Laser, laser photocoagulation; EBRT, external beam
radiotherapy; plaque, plaque radiotherapy; SCC, subconjuctival carboplatin; CV, vincristine, carboplatin plus thermotherapy or
cryotherapy; CEV, vincristine, etoposide, carboplatin plus thermotherapy or cryotherapy.
Note: May consider ICEV instead of CEV+SCC

Chemotherapy should be perform within 24 hours of local treatment by ophthalmologist
On the basis of the International Classification of Retinoblastoma, chemoreduction success is achieved in eye
survival rate 100% of group A, 93% of group B, 90% of group C, 47% of group D eyes, and 0% of group E.
Reference
Adapted from Carol L, Shields and Jerry A. Shields. Basic understanding of current classification and
management of retinoblastoma. Current Opinion in Ophthalmology 2006; 17: 228 – 234.
The regression pattern (examined by EUA) after treatment:

• Type I is calcification.
• Type II is fish flesh lesion.
• Type III is mixed type I and II.
• Type IV is flat scar.
Retinoblastoma: Summary treatment strategy based on laterality and retinoblastoma grouping 213
Schematic treatment for intraocular retinoblastoma
Unilateral retinoblastoma
-ICRB group E ie.Large tumor > 50% of globe volume

-No potential for visions
-Painful eyes
-Optic nerve involvement
N Y
ICRB Group A ICRB Group B ICRB Group C, D Enucleation
Cryotherapy Chemotherapy Protocol Chemotherapy Protocol High risk features: assessed by pathologist
and/or ThaiPOG-RB-I3-01 ThaiPOG-RB-13-02 -Anterior chamber seeding
Laser therapy (Carbo/VCR (Carbo/Eto/VCR) -Optic nerve tumor beyond lamina cribosa, but not to surgical margin
X 6 cycles) X 6 cycles for C -Choroidal involvement
-Intraocular hemorrhage
ThaiPOG-RB-13-03
-Posterior uveal involvement with any optic nerve disease (optic nerve
(Ifos/Carbo/Eto/VCR)
EBRT head, pre or postlaminar cribosa)
X 6-8 cycles for D
if not fully respond N Y
Low risk High risk
Enucleation or EBRT
if not fully responded
Schedule regular Chemotherapy Protocol
fundoscopic ThaiPOG-RB-13-02
examination (Carbo/VCR/Eto)
X 6 cycles
Schematic treatment for extraocular retinoblastoma
Extraocular retinoblastoma
Regional disease Metastatic diasese: CNS, bone, bone

- Disease at the surgical margin marrow involvement
- Orbital recurrence (orbital mass) - Isolated meningeal disease
- Tumor in an emissary canal - Ectopic intracranial retinoblastoma
(intrascleral involvement)
- Episcleral disease
- Positive pre-auricular lymph nodes Chemotherapy ThaiPOG-RB-13-05
(ICE protocol every 4 weeks x 6-8 cycles)
plus IT chemotherapy (ThaiPOG-RB-13-06) if positive CSF cytology
Enucleation
EBRT at orbit at week 6 + Chemotherapy Myeloablative chemotherapy and

Protocol ThaiPOG-RB-13-04 autologous stem cell rescue
(VCR/Ida/CTX alternate Eto/carbo EBRT for bulky disease at week 6 of SCT
every 3 weeks x 4 cycles)
Post-treatment evaluation
For patients with preserved eye
Evaluation Schedule Note
Eye examination under - Every 3-4 weeks until no active tumor on minimum 3 Patients should be
anesthesia (EUA) EUAs examined without
-Then every 6-8 weeks until 3 years of age anesthesia when old
-Then every 4-6 months until 10 years of age enough to cooperate.
-Then yearly
MRI brain and orbit -Every 6-12 months until 5 years of age
For patients after enucleation and/or received EBRT
Eye examination under -At 4-6 weeks post treatment Patients should be
anesthesia (EUA) -Then every 2-3 months in year 1 examined without
-Then every 3-4 months in year 2 anesthesia when old
-Then every 6 months until 5 years of age enough to cooperate.
-Then yearly
For patients with extraocular disease
CT or MRI of the brain and Every 6 months in first 3 years then every year until 5 - prefer MRI to avoid
orbits years after off treatment radiation exposure
CSF profiles and cytology Every 6 months in first 3 years then every year until 5
years after off treatment
Bone marrow aspiration and If unexplained cytopenia or bone scan positive
biopsy
Bone scan -Every 1 year for first 3 years
For patients with bilateral retinoblastoma, esp. whom diagnosed before 1 year of age or positive family
history
CT or MRI of the brain and Every 6 months from the end of treatment until 5 years - Screen for trilateral
orbits of age retinoblastoma
- prefer MRI to avoid
radiation exposure
For patients who received chemotherapy and/or radiation therapy
History and physical -Every 3 months until 2 years off treatment - Late effects of treatment
examination -Then every 6 months until 5 years off - Growth and development
treatment - Surveillance for second malignant
-Then yearly neoplasms (osteosarcoma, soft tissue
sarcomas, skin cancers, breast
cancers)
Visual acuity assessment -Yearly
CBC -Yearly for 10-15 years from exposure of -Surveillance for secondary leukemia
chemotherapy
Retinoblastoma: Post-treatment evaluation 216

Treatment Protocol for Retinoblastoma
Data entry form
Patient’s name......................................................... HN............................ Sex male female
Address...........................................................................................................................................................
..........................................................................Contact person....................................Tel............................
Father’s name........................................................ Age...........yr Occupation…………….............................
Mother’s name........................................................ Age...........yr Occupation…………….............................
Date of Birth (dd/mm/yy)......................................... Date of Diagnosis (dd/mm/yy) .....................................
Age ............. yr...............m. BW…...........kg Ht...............cm. BSA...................m2
สิทธิการรักษา บัตรประกันสุขภาพ จายตรง อื่นๆ (ระบุ) ...................................
History
Presenting S&S leukocoria orbital mass eye pain
Others……………………………………………………………..……….............…..
Prenatal History X-ray exposure
Medication……………………..………………..………………………………………
Illness…..……………………chemical exposure…..………………..……..……
Others………………………………………………………………………..……….…
Cancer in family None Retinoblastoma other cancers…..………..………
Physical examination Pedigree
Pre- treatment investigations.

A. Blood date (………/………/………)
CBC ………………………….…………………………..…………………………………………………………….
3
*start each course of chemotherapy when ANC > 1,000/mm
BUN …………Creatinine ………… LDH ………… SGOT …………SGPT …………… Alk Phos …………
Na …………… K ………………….. Cl …………… HCO3 …………… Ca …………..… Mg…….…………
B. Imaging study
CT/ MRI orbit and brain with contrast (………/………/………) ……………..……….……………..………….
…………………………………………………………………………………………………………………………
Chest X-Ray (……/……/…..…) Result positive………………………………………………negative
Lumbar Puncture : CSF cell count and cytospin (…../…../…..) Result positive…………………. negative
Bone scan (……/……/…..…) Result positive………………………………………………negative
* For patient with bone pain or extraocular disease only
C. Bone marrow for metastatic work up
Bone marrow aspiration* : Wright stain smear and clotted marrow sent for pathological review
(………/………/………) Result positive negative
*For patient with unexplained cytopenia or extraocular disease only
BMA/ biopsy (………/………/………) ……………………..…………………………………………………….….
Retinoblastoma: Data entry form 217

Treatment protocol for retinoblastoma [ThaiPOG-RB-13-01]

Protocol name ThaiPOG-RB-13-01
Protocol for Retinoblastoma ICRB group B
Reference: Orkin SH, et al. Oncology of Infancy and Childhood, 1st ed, 2009. P 576-601.
Lanzkowsky P. Manual of Ped Hematology and Oncology, 5th ed, 2011. P.759-775
Open Date January 2014
Patient’s name..................................................................... Sex........................... HN...........................................
Age (yy/mm)................................ BW............................. kg. Ht.............................cm BSA..............................m2
Inclusion criteria
Retinoblastoma ICRB group B
Given dose Drug Dosage Day

_______mg Vincristine 0.05 mg/kg or 1.5 mg/m2/day in NSS IV slowly push 1
(max 2 mg)
_______mg Carboplatin 18.6 mg/kg or 560 mg/m2/day in D5W IV in 15-30 min 1
*In patient BW < 12 kg, use doses per kg
• Give chemotherapy every 28 days for total 6 courses

• Give G-CSF 5 mcg/kg SC daily in subsequent course of chemotherapy that results in neutropenia
(to be started on day 2, at least 24 hours from last dose of chemotherapy, until ANC > 1,000/mm3)
• Criteria for starting chemotherapy:
o Absolute neutrophil count >1,000/ mm3
o Platelet count >100,000/ mm3
o ALT <10 × the upper limit of normal
o Normal glomerular filtration rate
• Fundoscopic examination by ophthalmologist before each cycle
• Hearing exam before starting chemotherapy, at cycle 3 or 4 and end of treatment (Optional)
• Consider EBRT if patient does not fully respond to chemotherapy
Retinoblastoma: Treatment protocol for retinoblastoma [ThaiPOG-RB-13-01] 218

Schedule of chemotherapy Protocol ThaiPOG-RB-13-01
Course Date BW / BSA Dose adjusted Note


Protocol for Retinoblastoma ICRB group C or Post enucleation with high risk features
Reference: Orkin SH,et al. Oncology of Infancy and Childhood, 1st ed, 2009. P 576-601.
Lanzkowsky P. Manual of Ped Hematology and Oncology, 5th ed, 2011. P.759-775
Inclusion criteria
Retinoblastoma ICRB group C
Retinoblastoma post enucleation with high risk features
Anterior chamber seeding Optic nerve tumor, but not to surgical margin
Choroidal involvement Intraocular hemorrhage
Posterior uveal involvement with any optic nerve disease

_______mg Vincristine 0.05 mg/kg or 1.5 mg/m2/day in NSS IV slowly push 1
(max 2 mg)
_______mg Carboplatin 18.6 mg/kg or 560 mg/m2/day in D5W IV in 15-30 min 1
_______mg Etoposide 5 mg/kg or 150 mg/m2/day IV in D5W IV in 60 min 1, 2
• Give chemotherapy every 28 days for total 6 courses

• Give G-CSF 5 mcg/kg SC daily in subsequent course of chemotherapy that results in neutropenia
(to be started on day 3, at least 24 hours from last dose of chemotherapy, until ANC > 1,000/mm3)
• Record BP q 15 min during etoposide infusion
• Hearing exam before starting chemotherapy, at cycle 3 or 4 and end of treatment (Optional)
• Consider enucleation or EBRT if patient does not fully respond to chemotherapy



Protocol for Retinoblastoma ICRB group D/ E
Reference: SH Lee. et.al, Bone Marrow Transplantation 2008; 42: 385-391
Inclusion criteria
Retinoblastoma ICRB group D
Retinoblastoma ICRB group E
Given dose Drug

Dosage Day
_______mg 60 mg/kg or 1,800 mg/m2/day in NSS IV drip in 30-60 min
Ifosfamide 0, 1, 2
_______mg 5 mg/kg or 150 mg/m2/day in D5W IV drip in 60 min
Etoposide 0, 1, 2
_______mg 20 mg/kg or 600 mg/m2/dose IV drip in 15 min before
Mesna 0, 1, 2
Ifosfamide then at 3, 6 hr after Ifosfamide (total 3 doses)
_______mg Carboplatin 18.6 mg/kg or 560 mg/m2/day in D5W IV drip in 15-30 min 0
_______mg Vincristine 0.05 mg/kg or 1.5 mg/m2 in NSS IV slowly push (max 2 mg) 0
* start G-CSF 5 mcg/kg __________ mcg OD after completion of chemotherapy 24 hr
** Hydration following high dose cyclophosphamide/ Ifosfamide guideline
• Give chemotherapy every 4 weeks until the tumor disappear, or until local therapy can control the
tumor
• Record water intake/ output and give diuretic if necessary
• Check CBC, BUN, Cr, Electrolyte, Ca2+, Mg2+, PO4 and LFT before start each course
• Consider hearing exam peroidically

10
11
12


Protocol for Extraocular Retinoblastoma: Regional disease
Reference: Chantada G, et.al. Cancer 2004;100(4): 834-842.
Inclusion criteria
Disease at the surgical margin Orbital recurrence (orbital mass)
Tumor in an emissary canal (intrascleral involvement) Episcleral disease
Positive pre-auricular lymph nodes
Evaluation extent of disease before treatment

Imaging studies .............................................................................................................................................
Bone scan .....................................................................................................................................................
CSF studies ……...........................................................................................................................................
BMA ..............................................................................................................................................................
Chemotherapy schedule
Week 0 3 6 9 12 15 18 21
Course A1 B1 A2 B2 A3 B3 A4 B4
Date
***** Start G-CSF at 24 -48 hr after completion each course of chemotherapy *****
Course A
__________mg Vincristine 0.05 mg/kg or 1.5 mg/m2 IV slowly push 1
__________mg Idarubicin 0.33 mg/kg or 10 mg/m2 IV infusion in 60 min 1
__________mg Cyclophosphamide* 65 mg/kg or 2,000 mg/m2 IV drip in 30-60 min 1
__________mg Mesna 30 mg/kg or 1,000 mg/m2 IV drip in in15 min 1
at 0,3 hr after CTX (total 2 doses)
In patient BW < 12 kg, use doses per kg
* hydration following High dose CTX guideline
Course B
__________mg Etoposide 3.3 mg/kg or 100 mg/m2 IV drip in 60 min 1-3
__________mg Carboplatin 18.6 mg/kg or 560 mg/m2 IV drip in 15-30 min 1-2
In patient BW < 12 kg, use doses per kg

• Record water intake/ output and give diuretic if necessary.
• Consider hearing exam periodically
A1
B1
A2
B2
A3
B3
A4
B4


Protocol for Metastasis retinoblastoma
Inclusion criteria
Retinoblastoma with CNS/ bone/ bone marrow involvement
Retinoblastoma with isolated meningeal disease
Ectopic intracranial retinoblastoma

___________mg Carboplatin 18.6 mg/kg or 560 mg/m2/day in D5W IV drip in 15-30 min 1
___________mg Ifosfamide 60 mg/kg or 1,800 mg/m2/day in NSS IV drip in 30-60 min 1-5
___________mg Mesna 15 mg/kg or 450 mg/ m2/dose IV drip in 15 min before 1-5
Ifosfamide, then at 3, 6, 9 hours post Ifosfamide (total 4
doses)
___________mg Etoposide 3.3 mg/kg or 100 mg/m2/day in D5W IV drip in 60 min 1-5
* start G-CSF 5 mcg/kg __________ mcg OD after completion of chemotherapy 24 hr
** Hydration following high dose Cyclophosphamide/ Ifosfamide guideline
• Give chemotherapy every 4 weeks

• Record water intake/output and give diuretic if necessary
• Consider myeloablative chemotherapy and autologous stem cell rescue
• EBRT for bulky disease at week 6 of SCT

Schedule of chemotherapy Protocol Thai-POG-13-05

Treatment protocol for intrathecal in retinoblastoma [ThaiPOG-RB-13-06]

Protocol for Retinoblastoma with CNS involvement
Reference: Adapted from Orkin's Oncology of Infancy and Childhood 1st ed, 2009 p.576-601
Patient’s name..................................................................... Sex.................. HN...........................................
* age adjusted dose intrathecal < 4mo 4– 11 mo 12-23 mo 24-36 mo >36 mo
chemotherapy
Methotrexate 3 6 8 10 12
Ara-C 10 20 30 50 70
• Give IT chemotherapy until CSF is negative 2 times consecutively with minimum 4 doses
Cycle week/ date given CSF result
1 week 0/
week 1/
week 2/
week 3/
2 week 4/
week 5/
week 6/
week 7/
3 week 8/
week 9/
week 10/
week 11/
4 week 12/
week 13/
week 14/
week 15/
Retinoblastoma: Treatment protocol for intrathecal in retinoblastoma [ThaiPOG-RB-13-06] 228

Retinoblastoma Guideline

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Thai Pediatric Oncology Group

Group A: Small intraretinal tumors away from foveola and disc

Retinoblastoma: Staging system 210

Pathologic classification (pTNM)

Retinoblastoma: Pathologic classification (pTNM) 211

Retinoblastoma: Investigations 212

Summary treatment strategy based on laterality and retinoblastoma grouping

Note: May consider ICEV instead of CEV+SCC

The regression pattern (examined by EUA) after treatment:

-ICRB group E ie.Large tumor > 50% of globe volume

ICRB Group A ICRB Group B ICRB Group C, D Enucleation

Regional disease Metastatic diasese: CNS, bone, bone

EBRT at orbit at week 6 + Chemotherapy Myeloablative chemotherapy and

Retinoblastoma: Post-treatment evaluation 216

Pre- treatment investigations.

Retinoblastoma: Data entry form 217

Treatment protocol for retinoblastoma [ThaiPOG-RB-13-01]

Given dose Drug Dosage Day

• Give chemotherapy every 28 days for total 6 courses

Retinoblastoma: Treatment protocol for retinoblastoma [ThaiPOG-RB-13-01] 218

Schedule of chemotherapy Protocol ThaiPOG-RB-13-01

Course Date BW / BSA Dose adjusted Note

Retinoblastoma: Treatment protocol for retinoblastoma [ThaiPOG-RB-13-01] 219

Treatment protocol for retinoblastoma [ThaiPOG-RB-13-02]

Given dose Drug Dosage Day

• Give chemotherapy every 28 days for total 6 courses

Retinoblastoma: Treatment protocol for retinoblastoma [ThaiPOG-RB-13-02] 220

Course Date BW / BSA Dose adjusted Note

Retinoblastoma: Treatment protocol for retinoblastoma [ThaiPOG-RB-13-02] 221

Treatment protocol for retinoblastoma [ThaiPOG-RB-13-03]

Given dose Drug

Retinoblastoma: Treatment protocol for retinoblastoma [ThaiPOG-RB-13-03] 222

Course Date BW / BSA Dose adjusted Note

Retinoblastoma: Treatment protocol for retinoblastoma [ThaiPOG-RB-13-03] 223

Treatment protocol for retinoblastoma [ThaiPOG-RB-13-04]

Evaluation extent of disease before treatment

Retinoblastoma: Treatment protocol for retinoblastoma [ThaiPOG-RB-13-04] 224

Course Date BW / BSA Dose adjusted Note

Retinoblastoma: Treatment protocol for retinoblastoma [ThaiPOG-RB-13-04] 225

Treatment protocol for retinoblastoma [ThaiPOG-RB-13-05]

Given dose Drug Dosage Day

• Give chemotherapy every 4 weeks

Retinoblastoma: Treatment protocol for retinoblastoma [ThaiPOG-RB-13-05] 226

Course Date BW / BSA Dose adjusted Note

Retinoblastoma: Treatment protocol for retinoblastoma [ThaiPOG-RB-13-05] 227

Treatment protocol for intrathecal in retinoblastoma [ThaiPOG-RB-13-06]

Retinoblastoma: Treatment protocol for intrathecal in retinoblastoma [ThaiPOG-RB-13-06] 228

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