Treatment of eye tumors

For eyelid tumours, the gold standard of treatment is initial surgery, which - if performed early - allows the patient to recover without sequelae. In more advanced forms, broader surgery with immediate reconstruction of the eyelid is recommended. Histological results are discussed at a regional multidisciplinary consultation meeting (RCP), with the Rothschild Foundation and the Quinze-Vingts national ophthalmology hospital. This surgery may be accompanied by a targeted therapy called vismodegib in the case of basal cell carcinoma, contact radiotherapy using rays directly on the area to be treated (contactotherapy) or external radiotherapy.

Malignant tumors of the eyelid (such as squamous cell carcinomas, sebaceous carcinomas or Merkel tumors) are generally treated with a combination of surgery and radiotherapy. Their management benefits from a multidisciplinary approach and recent biological advances.

Because of their severity, malignant conjunctival tumors require early and appropriate treatment. In particular, conjunctival carcinomas are epithelial tumors whose prognosis depends on the initial size, prior surgeries, the number of local relapses and the histological aggressiveness. When the tumor is well managed with a combination of surgery and Curietherapy or protontherapy, good local control can be achieved with minimal ocular sequelae. This treatment also prevents the risk of lymph node relapse and metastasis. These tumors can also be treated with eye-drop chemotherapy (5FU or mitomycin C).

Diagnosis of conjunctival melanoma requires referral to a specialized center, such as Institut Curie. Treatment is based on surgical excision (i.e., removal), followed by complementary radiotherapy, the modalities of which are discussed at a multidisciplinary consultation meeting (RCP): protontherapy, iodine disk Curietherapy or contact therapy, depending on the tumor's location, invasiveness or size. Testing for BRAF, RAS or KIT mutations can also help guide the choice of targeted therapy or immunotherapy in the case of lymph node involvement or metastatic disease. Research in conjunctival melanoma is also being conducted on mutations found in tumors.

Based on the results of the biopsy, management of conjunctival lymphoma is discussed at the MCM, with hematologists and radiotherapists. If the conjunctival lymphoma is isolated with no hematological involvement, treatment based on external radiotherapy may be discussed. In the absence of symptoms or clinical discomfort, the lesion can simply be monitored, without necessarily being treated.

The choice of treatment for uveal melanoma is made at the MCM, depending on the patient's age, the size of the tumour, its location in the eye, its extension beyond the sclera (white of the eye) and any histological analysis: surgery, Curietherapy, protontherapy. If possible, the aim is to preserve sight.

Retinoblastoma

The challenge of retinoblastoma treatment is to ensure children's survival, preserve their eyeballs and, if possible, their vision. Retinoblastoma has a positive prognosis, provided that it is diagnosed early. In 60% of patients, enucleation is still necessary in unilateral forms, and for one eye in bilateral forms, because at the time of diagnosis the tumour is often already too extensive. When conservative treatment is possible, it is essentially based on chemotherapy injected directly into the ophthalmic artery or intravenously, complemented by local ophthalmological treatments (laser, cryotherapy, intravitreal injection of chemotherapy directly into the eyeball, etc.), aimed at preserving the child's vision as much as possible. Recent advances at Institut Curie have made it possible to identify the mutation at the origin of retinoblastoma, by means of a small puncture in the anterior chamber of the eye. When the eyeball is preserved, this analysis can be used to search for the mutation throughout the body, and can be used for genetic counseling (sibling screening) in the event of new parental projects.