Algorithmic overview of initial treatment options for children with newly diagnosed retinoblastoma based on disease classification*

* This algorithm is intended for use in conjunction with additional UpToDate content on retinoblastoma in children. Refer to UpToDate topics on retinoblastoma for additional details of the approach to treatment and the overall efficacy of these treatments.
¶ Enucleation may be required for some group D tumors.
Δ Adjuvant chemotherapy and radiotherapy are provided following enucleation if there are microscopic residua at the cut section of the optic nerve or sclera, or if there are other pathologic risk factors.
◊ For patients who have undergone enucleation of one eye, systemic or intra-arterial chemotherapy can be used in attempt to salvage the other eye. These therapies may also be used in patients with bilateral advanced disease in attempt to salvage both eyes.
§ Some group B tumors can be treated with focal therapies (eg, laser photocoagulation, cryotherapy); however, for larger tumors and those that impinge on the fovea, local or systemic chemotherapy is typically used to shrink the tumor before performing focal therapy.