Treatment of Retinoblastoma in Germany
Best children's hospitals and doctors for retinoblastoma treatment in Germany
Leading hospitals
Cost for treatment
Retinoblastoma is the most common eye tumor in children, accounting for 15% of all neoplasms in the first year of life. The disease is caused by a mutation in the RB1 gene, which normally should keep cells from growing uncontrollably. In every third case, this mutation is congenital. The hereditary form of a mutation occurs occasionally. The risk of developing malignant tumors in these children remains elevated throughout their lives.
In a natural course, retinoblastoma grows and occupies most of the eye. Retinoblastoma spreads and new tumors develop. They block the outflow of aqueous humor, so a child develops glaucoma. Over time, vision loss may develop. If cancer spreads beyond the eyeball, it can metastasize to the lymph nodes and then to other organs, namely the liver, bones, or bone marrow. Cancer spreads along the optic nerve to the brain.
However, most cancers are detected before retinoblastoma has spread in the body. If you are undergoing your treatment in Germany, you can count not only on the complete cure of the disease, but also on the preservation of your vision. You are welcome to use the Booking Health service to undergo your diagnostics and treatment at one of the German hospitals. On the website, you can find the cost of treatment, compare prices, and choose the best medical care program.
Content
- Surgical treatment of retinoblastoma
- Radiation therapy for retinoblastoma
- Treatment of retinoblastoma with a laser
- Cryotherapy for retinoblastoma
- Chemotherapy for retinoblastoma
- Stem cell transplant for retinoblastoma
- Where to undergo retinoblastoma treatment?
Surgical treatment of retinoblastoma
In the twentieth century, surgical treatment of retinoblastoma was considered the main one. It is still widely used in countries with poorly developed medicine. However, surgical treatment of retinoblastoma in Germany is becoming less and less common. Doctors resort to operations only in the advanced stages of the disease, while small tumors can be destroyed with more sparing techniques, which will provide the full preservation of vision.
Enucleation of the eye involves its total removal, along with a part of the optic nerve. This surgical procedure can be performed for the advanced stage of the disease if vision has already been lost and it cannot be restored. The technique can also be used in the case of tumor recurrence and if other treatment methods do not cure retinoblastoma. The operation is performed under general anesthesia. Doctors insert a silicone or hydroxyapatite implant into the orbit instead of the patient's own eyeball. This implant cannot restore vision, but provides a normal patient's appearance. The artificial eye is attached to the muscles so it moves in sync with the patient's own remaining eye.
Radiation therapy for retinoblastoma
Radiation therapy is one of the main treatment methods for retinoblastoma in Germany. The following radiation therapy options can be used:
- external beam radiation therapy;
- internal radiation therapy (brachytherapy).
In the past, external beam radiation therapy was considered the main treatment method. Now it is used less frequently due to its side effects. However, this technique is still used, mainly in cases where the tumor cannot be destroyed with brachytherapy.
New methods of radiotherapy are used for treatment in Germany, which are distinguished by their high safety:
Intensity-modulated radiation therapy allows doctors to direct the beams to the target from different sides, at different angles, and change the intensity of the irradiation. As a result, a more even distribution of radiation exposure is achieved, damage to the surrounding tissues is reduced, and the risk of developing post-radiation complications is minimal.
Proton beam therapy is an innovative method of irradiation available in only six hospitals in Germany. Most foreign patients visit the University Hospital Essen or the University Hospital Heidelberg for retinoblastoma treatment with protons. The difference of protons is that they almost do not irradiate the tissues through which they pass. This is the safest method for tumor irradiation. It is with its help that it is better to treat retinoblastoma in children. The widespread use of this method is still limited by the high cost of treatment.
Brachytherapy involves the placement of the radioactive material in the eye and leaving it there for several days. The tissues located next to the tumor are protected by a gold or lead plate. The irradiation is very short, so it practically does not damage the tissues located beyond the tumor.
Treatment of retinoblastoma with a laser
Only early-stage retinoblastoma can be treated with a laser.
Laser photocoagulation is a procedure, during which a laser beam is directed through the pupil and affects the blood vessels that supply the tumor. This blood vessel loses its blood supply and dies. The procedure is effective for small neoplasms that are located in the posterior chamber of the eye. The procedure is carried out 2-3 times, with breaks of 4 weeks. It is best to undergo your retinoblastoma treatment with this method in a good clinic with extensive experience to avoid retinal lesions.
Transpupillary thermal therapy, or simply thermotherapy, is a procedure involving the use of different types of a laser. This laser does not heat the blood vessels, but the retinoblastoma itself. Tumor cells are destroyed, but the blood vessels are intact.
The procedure is carried out as a stand-alone treatment method for small retinoblastomas, and if the tumor is large, then thermotherapy can be combined with chemotherapy or radiation therapy. These techniques are called thermochemotherapy and thermoradiation therapy, respectively. Although doctors often use radiotherapy alone to destroy a tumor, trials show that when combined with tumor heating, this technique works better.
In total, three procedures with an interval of 1 month are required. One procedure takes 10 minutes. It is performed under anesthesia. When combined with chemotherapy, the manipulation is performed a few hours after the administration of drugs.
Cryotherapy for retinoblastoma
Cancer can be destroyed by critically low temperatures. Doctors use a thin metal probe that is delivered to the tumor. The probe freezes retinoblastoma cells, which die when thawed.
The procedure can be used only for single small tumors located in the anterior chamber of the eye. In children, cryoablation is performed under anesthesia. During a single procedure, the retinoblastoma is frozen several times. In total, 2-3 procedures are required.
Chemotherapy for retinoblastoma
For the treatment of retinoblastoma, doctors use not only systemic, but also local and regional chemotherapy. Systemic chemotherapy involves the administration of drugs orally or intravenously so that they enter the bloodstream and are distributed throughout the body. In the case of local chemotherapy, drugs are delivered directly to the tumor, while regional chemotherapy involves the injection of drugs into the artery that supplies the tumor.
Systemic chemotherapy
Systemic chemotherapy is used mainly for the advanced stage of retinoblastoma. It is a less common treatment option for early-stage cancer, if only a local procedure is not enough to completely destroy the tumor.
Medicines are administered intravenously. Chemotherapy continues for several months. A combination of three drugs is most often used. When treating early stages of cancer, only two drugs can be used.
Intravitreal chemotherapy
Intravitreal chemotherapy involves the injection of drugs into the vitreous body, which is a jelly-like substance inside the eye. A very thin needle is used for the injection. The procedure can be combined with systemic or intra-arterial chemotherapy.
Intra-arterial chemotherapy
Regional chemotherapy is a minimally invasive vascular procedure under X-ray guidance. Doctors make a small incision in the leg to insert a catheter into the bloodstream. They reach the ophthalmic artery and inject a chemotherapy drug into it. This procedure is repeated once every few weeks until the retinoblastoma completely disappears.
The procedure is safe and does not cause any of the typical side effects of systemic chemotherapy. About 10% of the dose that doctors would have to inject intravenously as part of systemic chemotherapy is sufficient to achieve a therapeutic effect. This type of treatment often saves an eye that would otherwise have to be completely removed.
Intrathecal chemotherapy
This type of chemotherapy can be used in cases where retinoblastoma has spread to the central nervous system. This occurs in the advanced stages of the disease.
Intrathecal chemotherapy involves the injection of drugs into the cerebrospinal fluid. This requires an injection in the lumbar region. The procedure is safe. The procedure is safe. Any spinal cord injuries in a child are impossible because doctors inject drugs at the end of the cord.
Intrathecal chemotherapy can shrink the size of retinoblastoma or even make it disappear. However, sooner or later, a recurrence usually occurs, and this can only be avoided with the help of a stem cell transplant.
Stem cell transplant for retinoblastoma
A bone marrow transplant can even cure patients with advanced retinoblastoma. Doctors transplant the child's own stem cells. They are harvested from the bone marrow or peripheral blood.
This process is followed by high-dose chemotherapy. Doctors use higher doses of drugs than usual to cure cancer completely. This treatment destroys the bone marrow. It is irreversibly damaged and can no longer produce blood cells.
In the next stage of treatment, doctors inject the patient's stem cells intravenously. It will take a few more weeks before the hematopoietic function is restored, and the child will spend this time in a sterile box. The child receives antibiotics and antiviral agents as the body's immunity temporarily does not work.
Where to undergo retinoblastoma treatment?
Germany is the best choice for the diagnosis and treatment of cancer. This country offers advanced medicine, hospitals are equipped with state-of-the-art devices, and the latest medical technologies are available to deal with malignant tumors. At the same time, the cost of treatment here is far from the highest as compared to other developed countries. For example, prices in Germany are lower as compared to North America, Japan, and Nordic countries.
There are a few reasons for you to undergo your treatment at a German hospital. These are as follows:
- high-precision diagnosis using advanced equipment allows doctors to plan treatment perfectly;
- early-stage eye cancer can be treated with photocoagulation or thermotherapy;
- in the vast majority of cases, doctors prefer organ-preserving treatment, which is no less effective than removing the eye;
- availability of new methods of radiotherapy, including IMRT, proton therapy, and brachytherapy;
- low risk of post-radiation complications;
- German doctors inject drugs into the artery that supplies the eye instead of systemic chemotherapy, which causes many side effects;
- doctors in Germany perform a stem cell transplant so even advanced stages of the disease with multiple metastases can be cured.
You are welcome to use the Booking Health service to find the cost of treatment in different hospitals, compare prices, and choose a medical care program for the most preferred dates. The Booking Health employees will help you to select the best medical center for retinoblastoma treatment and arrange your trip. The cost of cancer treatment will be lower for you than if you go directly to the hospital. If you make your treatment appointment through the Booking Health service, prices will be reduced for you due to the absence of additional fees for foreign patients.
Authors:
The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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