中华眼底病杂志

中华眼底病杂志

视网膜母细胞瘤治疗中需要考虑的要点

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随着视网膜母细胞瘤(RB)治疗技术的明显进展,更多患者有机会在生命面临极小风险的前提下得以保存眼球和视功能。尽管目前有冷冻、激光光凝、全身化疗、眼球摘除手术以及通过眼内、球周和眼动脉介入途径的局部化疗等多种治疗方式可供选择,但要形成合理的治疗方案并取得良好疗效仍有些许要点需要考虑。如明确RB是不是眼内期、眼内期肿瘤是选择保眼治疗还是眼球摘除、保眼治疗在何种情况联合化疗、如何安排RB患者的随诊及后续治疗等。在实际临床工作中,制定RB治疗方案时要面临的问题可能更为复杂,应全面综合地评估患者病情、社会经济状况、就诊条件等具体情况,必须明确任何治疗均应遵循保生命为前提的保眼、挽救视功能这一RB治疗原则。

Thanks to the treatment of retinoblastoma (RB) having improved significantly in recent years, there is an increasing trend to use conservative treatment modalities that aim to preserve the globe as well as vision with minimum mortality. RB therapy is a long-term systemic treatment in clinical practice. Although there are many treatment options for RB therapy, such as cryotherapy, photocoagulation, systemic chemotherapy, enucleation and ophthalmic chemotherapy, it is recommended to consider in accordance with the following key points in gaining a reasonable treatment strategies: to make sure that RB is an intraocular period; to determine whether the intraocular RB to be treated with eye preservation or enucleation; what is the case of eye preservation therapy combined with chemotherapy and how to arrange the follow-up of RB patients. It's more complicated to choice the therapeutic measures for RB in clinical practice. So, the patient's condition, economic capability and medical condition should be evaluated comprehensively. The principle of RB treatment should be followed, which is protecting eyeball and visual function without life damage.

关键词: 视网膜母细胞瘤/外科学; 视网膜母细胞瘤/药物疗法; 化学疗法,肿瘤,局部灌注; 冷冻疗法; 激光凝固术; 述评

Key words: Retinoblastoma/surgery; Retinoblastoma/drug therapy; Chemotherapy, cancer, regional perfusion; Cryotherapy; Laser coagulation; Editorial

引用本文: 梁建宏. 视网膜母细胞瘤治疗中需要考虑的要点. 中华眼底病杂志, 2018, 34(3): 208-211. doi: 10.3760/cma.j.issn.1005-1015.2018.03.002 复制

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1. Antoneli CB, Steinhorst F, de Cássia Braga Ribeiro K, et al. Extraocular retinoblastoma: a 13-year experience[J]. Cancer, 2003, 98(6):1292-1298. DOI: 10.1002/cncr.11647.
2. Shah PK, Narendran V, Kalpana N. Outcomes of intra- and extraocular retinoblastomas from a single institute in South India[J]. Ophthalmic Genet, 2015, 36(3):248-250. DOI: 10.3109/13816810.2013.867450.
3. Rodriguez-Galindo C, Wilson MW, Haik BG, et al. Treatment of metastatic retinoblastoma[J]. Ophthalmology, 2003, 110(6):1237-1240. DOI: 10.1016/S0161-6420(03)00258-6.
4. Kaliki S, Shields CL, Rojanaporn D, et al. High-risk retinoblastoma based on international classification of retinoblastoma: analysis of 519 enucleated eyes[J]. Ophthalmology, 2013, 120(5):997-1003. DOI: 10.1016/j.ophtha.2012.10.044.
5. Shields CL, Shields JA. Basic understanding of current classification and management of retinoblastoma[J]. Curr Opin Ophthalmol, 2006, 17(3):228-234. DOI: 10.1097/01.icu.0000193079.55240.18.
6. Lee JH, Han JW, Hahn SM, et al. Combined intravitreal melphalan and intravenous/intra-arterial chemotherapy for retinoblastoma with vitreous seeds[J]. Graefe's Arch Clin Exp Ophthalmol, 2016, 254(2):391-394. DOI: 10.1007/s00417-015-3202-0.
7. Fabian ID, Stacey AW, Johnson KP, et al. Primary intravenous chemotherapy for group D retinoblastoma: a 13-year retrospective analysis[J]. Br J Ophthalmol, 2017, 101(1):82-88.DOI: 10.1136/bjophthalmol-2016-309710.
8. Kunkele A, Jurklies C, Wieland R, et al. Chemoreduction improves eye retention in patients with retinoblastoma: a report from the German Retinoblastoma Reference Centre[J].Br J Ophthalmol, 2013, 97(10):1277-1283. DOI: 10.1136/bjophthalmol-2013-303452.
9. Shields CL, Alset AE, Say EA, et al. Retinoblastoma control with primary intra-arterial chemotherapy: outcomes before and during the intravitreal chemotherapy era[J]. J Pediatr Ophthalmol Strabismus, 2016, 53(5):275-284.DOI: 10.3928/01913913-20160719-04.
10. Munier FL, Mosimann P, Puccinelli F, et al. First-line intra-arterial versus intravenous chemotherapy in unilateral sporadic group D retinoblastoma: evidence of better visual outcomes, ocular survival and shorter time to success with intra-arterial delivery from retrospective review of 20 years of treatment[J]. Br J Ophthalmol, 2017, 101(8):1086-1093. DOI: 10.1136/bjophthalmol-2016-309298.
11. Abramson DH, Shields CL, Jabbour P, et al. Metastatic deaths in retinoblastoma patients treated with intraarterial chemotherapy (ophthalmic artery chemosurgery) worldwide[J]. Int J Retina Vitreous, 2017, 3:40. DOI: 10.1186/s40942-017-0093-8.
12. Francis JH, Abramson DH, Ji X, et al. Risk of extraocular extension in eyes with retinoblastoma receiving intravitreous chemotherapy[J]. JAMA Ophthalmol, 2017, 135(12):1426-1429. DOI: 10.1186/s40942-017-0093-8.
13. Francis JH, Brodie SE, Marr B, et al. Efficacy and toxicity of intravitreous chemotherapy for retinoblastoma: four-year experience[J]. Ophthalmology, 2017, 124(4):488-495.DOI: 10.1001/jamaophthalmol.2017.4600.
14. Canadian Retinoblastoma Society. National Retinoblastoma Strategy Canadian Guidelines for Care: stratégie thérapeutique du rétinoblastome guide clinique canadien[J]. Can J Ophthalmol, 2009, 44 Suppl 2:S1-88. DOI: 10.3129/i09-194.