First-line chemotherapy with local treatment can prevent external-beam irradiation and enucleation in low-stage intraocular retinoblastoma
First-line chemotherapy with local treatment can prevent external-beam irradiation and enucleation in low-stage intraocular retinoblastoma
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DOI：
10.1200/jco.2000.18.15.2881
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发表时间：
2000-08-01
影响因子：
45.3
通讯作者：
Munier, F
中科院分区：
文献类型：
--
作者：
Beck, MN;Balmer, A;Munier, F
目的：评价一线化疗（CT）对视网膜母细胞瘤（Rbl）患者预防外束放疗（EBR）和/或去核的疗效。患者和方法：24例新诊断的单侧或双侧Rbl患者行CT联合局部治疗（LT）。根据肿瘤反应，每隔3- 4周给予依托泊苷和卡铂2 - 5个疗程，每次通过LT完成。结果：所有眼睛均观察到肿瘤反应，24例患者中有21例ct完全缓解（CR）， ct中位随访（FU）持续31个月（范围，4至41个月）。在3例复发患者中，2例死于FU， 1例死于疾病进展。21例病情较轻的患者（I至III组）中有15例（71.4%）仅通过CT和LT达到CR，另外6例病情较晚期的患者（IV组和V组）治疗失败，需要通过EBR和/或去核进行挽救性治疗。两组患者在疾病分期方面的差异具有统计学意义（P < 0.0001）， 19例患者中有13例（68.4%）可以避免EBR，其中I至III组（15眼）和V组（1眼）疾病，而5例患者中只有2例（40%）可以避免去核。结论：CT联合强化LT对I - III组Rbl患者是有效的，可以避免大多数年幼儿童发生EBR，从而降低长期后遗症的风险。这与IV组和V组Rbl患者令人失望的结果形成对比，这些患者需要EBR和/或去核。中华临床杂志，18(2):2881-2887。(C) 2000年由美国临床肿瘤学会出版。
Purpose: To evaluate the efficacy of first-line chemotherapy (CT) in preventing external-beam radiotherapy (EBR) and/or enucleation in patients with retinoblastoma (Rbl).Patients and Methods: Twenty-four patients with newly diagnosed unilateral or bilateral Rbl received CT associated with local treatment (LT). Two to five courses of etoposide and carboplatin were administered at 3- to 4-week intervals, depending on tumor response, and were completed each time by LT,Results: Tumor response was observed in all eyes, Twenty-one of 24 patients showed ct complete response (CR) that persisted at ct median follow-up (FU) of 31 months (range, 4 to 41 months). Among the three patients who relapsed, two were lost to FU and one died of progressive disease. CR was achieved by CT and LT alone in 15 (71.4%) of 21 patients with less advanced disease (groups I to III), Six other patients with advanced disease (groups IV and V) experienced treatment failure and needed salvage treatment by EBR and/or enucleation. The difference between the two patient groups with regard to disease stage wets statistically significant (P < .0001), EBR could be avoided in 13 (68.4%) of 19 patients, who presented with groups I to III (15 eyes) and group V (one eye) disease, whereas enucleation could be avoided in only two (40%) of five.Conclusion: CT combined with intensive LT is effective in patients with groups I to III Rbl, permitting the avoidance of EBR in the majority of these young children and, thus, reducing the risk of long-term sequelae. This is in contrast with the disappointing results for patients with groups IV and V Rbl, in whom EBR and/or enucleation was needed. J Clin Oncol 18:2881-2887. (C) 2000 by American Society of Clinical Oncology.