How We Approach Intraocular Retinoblastoma in 2026: Agreement and Disagreement in Four Referral Centers in the USA and Europe.

Retinoblastoma management has changed notably in the past 11 years. Here, four retinoblastoma experts in the USA and Europe report their management recommendations. Retinoblastoma is now the most curable of all pediatric cancers in developed countries, and major clinical trials are scarce; thus, the experience of these centers carries important information for clinicians worldwide. There is increasing use of intra-arterial chemotherapy for unilateral and bilateral disease in naïve and recurrent eyes. Intravitreal chemotherapy is increasingly being used, and high-dose topotecan for vitreous seeds, anterior chamber tumor (combined with intracameral injection), and recurrent retinal and subretinal tumors is becoming the standard approach.