Most B/L multifocal retinoblastoma require –
**Core Concept**
Retinoblastoma is a malignant tumor of the retina, most commonly affecting children. Bilateral (B/L) multifocal retinoblastoma indicates the presence of multiple tumors in both eyes, posing a significant challenge in management.
**Why the Correct Answer is Right**
In bilateral multifocal retinoblastoma, the primary goal is to preserve vision and prevent tumor spread. Enucleation (removal of the eye) is often considered when there is extensive disease, but in cases with multiple foci in both eyes, chemotherapy is the preferred initial treatment. Chemotherapy helps to shrink tumors, reducing the risk of further spread and preserving vision. This approach is particularly effective in cases where the tumor is confined to the retina.
**Why Each Wrong Option is Incorrect**
**Option A:** Enucleation of the affected eye is not the first-line treatment for bilateral multifocal retinoblastoma, as it would remove the eye without addressing the potential disease in the contralateral eye.
**Option B:** External beam radiation therapy is not typically used as the primary treatment for bilateral multifocal retinoblastoma, due to its potential for long-term side effects, such as cataracts and secondary malignancies.
**Option C:** Laser photocoagulation is a treatment option for small retinoblastoma tumors, but it is not suitable for multifocal disease, as it would require repeated treatments and may not be effective for larger tumors.
**Clinical Pearl / High-Yield Fact**
In retinoblastoma management, the International Classification of Intraocular Retinoblastoma (ICIR) is a valuable tool for predicting the likelihood of tumor spread and guiding treatment decisions.
**Correct Answer: A. Chemotherapy**