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[Current therapeutic management in retinoblastoma with invasion of the optic nerve--a case report].

INTRODUCTION
Retinoblastoma is the most frequent primitive intraocular tumour in children. The extension of retinoblastoma at the optic nerve level gives a dark prognosis implying a complex treatment and a long period of supervision.


OBSERVATION
An eleven-months-old child, female, is taken in the hospital with the suspicion of retinoblastoma left eye. The diagnosis was suspected when the child was six months old within another ophthalmologic department, but the treatment was postponed. Surgical treatment consisted of enucleation with at least a 10 mm resection of the optic nerve. The anatomo-pathologic examination shows a retinoblastoma with the optic nerve invasion (stage II b 2--after Grabowski's classification). Because of the early age of the patient, we are obliged to give up applying radiotherapy (technical reasons) and systemic chemotherapy is recommended, in six cycles, under very severe clinic and paraclinic control.


CONCLUSIONS
The extension of retinoblastoma at the optic nerve level indicates a severe prognosis with high lethal risk. The correct treatment during thus phase implies the association of radiotherapy (40-45 Gy) and chemotherapy. After 24 months from the finishing of the treatment the patient is in total remission (clinic and paraclinic), but the supervision is going on for at least another 3 years. The early enucleation as well as its appliance with the removal of a large part of the optic nerve represents a therapeutical manner and leads to an important prognosis.