Clinical trials for children and adolescents with cancer are generally designed to compare potentially better therapy with therapy that is currently accepted as standard. The majority of the progress made in identifying curative therapies for childhood cancers has been achieved through clinical trials. For information regarding ongoing clinical trials for children and adolescents with cancer, consult the PDQ protocol file. The presentation and clinical course for patients older than 5 years of age may differ from those of younger patients. The germline form of retinoblastoma may manifest as unilateral or bilateral disease.
Most unilateral disease is sporadic, whereas all bilateral disease is germline.
Germline tumors tend to occur at a younger age than sporadic tumors. Unilateral tumors in infants are more likely to have germline mutations, whereas older children with unilateral tumors are more likely to have sporadic tumors. It is recommended that they be examined every 2 to 4 months for at least 28 months. It also has been found that patients who are asymptomatic at the time of diagnosis with an intracranial tumor have a better overall survival than patients who are symptomatic. Screening by neuroimaging may improve the cure rate if cases of trilateral retinoblastoma are detected during the first year after diagnosis.