中华眼底病杂志

中华眼底病杂志

经眼动脉灌注化学药物治疗视网膜母细胞瘤临床疗效观察

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目的 观察经眼动脉灌注化学药物治疗(IAC)视网膜母细胞瘤(RB)患儿的疗效和安全性。 方法 经全身静脉化学药物治疗(全身化疗)后再行IAC的RB患儿34例42只眼纳入研究。其中,男性26例,女性8例。平均年龄14.1个月。双眼21例,单眼7例。42只眼中,国际RB分期B、C、D、E期为1、3、32、6只眼,分别占2.4%、7.1%、76.2%、14.3%。全身化疗后肿瘤复发、瘤体增大者分别为4、10只眼,分别占9.0%、24.0%;序贯IAC者28只眼,占67.0%。所有患眼均接受IAC联合激光光凝、冷冻等眼局部治疗。IAC方案采用联合、交替给药方式,单数次IAC为美法仑联合卡铂灌注;偶数次IAC为美法仑联合拓扑替康灌注。根据IAC后瘤体情况决定是否再次IAC。瘤体增大、玻璃体或视网膜下种植增多终止IAC,行眼球摘除手术。保眼患儿末次IAC后平均随访时间(21.4±3.7)个月;眼球摘除患儿行眼球摘除手术后结束随访,平均随访时间(6.2±2.9)个月。观察IAC后瘤体控制情况以及眼局部并发症和全身不良反应及骨髓抑制程度。 结果 42只眼平均行IAC为(4.0±0.9)次。42只眼中,肿瘤钙化或形成瘢痕或呈鱼肉状改变32只眼,保眼率76.2%。其中,B、C、D、E期分别为1、1、27、3只眼,保眼率分别100.0%、33.3%、84.4%、50.0%。行眼球摘除手术10只眼。其中,IAC后瘤体无缩小2只眼;肿瘤复发3只眼;玻璃体积血3只眼;眼球萎缩1只眼;瘤体玻璃体广泛种植1只眼。34例患儿中,出现眼睑肿胀18例;玻璃体积血、眼球萎缩分别为3、1例。全身出现Ⅰ~Ⅳ度骨髓抑制22例。 结论 IAC对眼内RB有较好疗效,但仍存在肿瘤复发;未见严重眼局部和全身并发症。

Objective To analyze the efficacy and safety of Intra-arterial chemotherapy (IAC) as secondly treatment in children with retinoblastoma (RB). Methods 42 eyes of 34 consecutive RB patients were enrolled in the study after intravenous chemotherapy (IVC), including 26 males and 8 females. The average age is 14.1 months. 21 cases were bilateral and 7 cases were unilateral. A total of 42 eyes of 34 patients were classified according to the International Intraocular Retinoblastoma Classification(IIRC)as group B(n=1, 2.4%), group C (n=3, 7.1%), group D (n=32, 76.2%), or group E (n=6, 14.3%). Tumor recurrence and tumor enlargement after IVC were 4 and 10 eyes respectively, accounting for 9.0% and 24.0% respectively. Sequential treatment after IVC followed by IAC were 28 eyes, accounting for 67.0%. All treatment eyes received IAC combined with laser, cryotherapy and other eye local treatment. The IAC regimen adopted the combination and alternation administration mode, by the combination of melphalan and carboplatin or the combination of melphalan and topotecan. According to the tumor changes after IAC decide whether IAC again. If tumors increased, vitreous or subretinal implants increased will be termination of IAC and enucleation. The mean follow-up time was (21.4±3.7) months after the last IAC treatment and (6.2±2.9) months after enucleation. Ocular preservation rate and complication were evaluated. Results The average IAC procedures performed on 42 eyes were (4.0±0.9). An overall ocular preservation rate of 76.2% was observed during follow-up periods due to calcification or inactivation of tumors (32 eyes), including group B (n=1, 100%), group C (n=1, 33.3%), group D (n=27, 84.4%), group E (n=3, 50%). 10 eyes were enucleated. Among them, 2 eyes of the tumor did not shrink after IAC, tumor recurrence (n=3), vitreous hemorrhage (n=3), enophthalmos (n=1), vitreous disseminated (n=1). 34 cases of children, transient eyelid oedema were 18 cases, vitreous hemorrhage and bone marrow suppression (Ⅰ-Ⅳ) were 1, 22 casese respectively. Conclusions IAC as secondly treatment is safe and effective for RB patients, however, there is still tumor recurrence. No serious ocular local and systemic complications were observed.

关键词: 视网膜母细胞瘤/药物疗法; 化学疗法,肿瘤,局部灌注; 治疗结果

Key words: Retinoblastoma/drug therapy; Chemotherapy, cancer, regional perfusion; Treatment outcome

引用本文: 姜华, 方倩, 邓海浪, 夏杰军, 罗芳, 张靖. 经眼动脉灌注化学药物治疗视网膜母细胞瘤临床疗效观察. 中华眼底病杂志, 2017, 33(6): 612-615. doi: 10.3760/cma.j.issn.1005-1015.2017.06.014 复制

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