Risk factors for extraocular relapse following enucleation after failure of chernoreduction in retinoblastoma
Risk factors for extraocular relapse following enucleation after failure of chernoreduction in retinoblastoma
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DOI：
10.1002/pbc.21067
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发表时间：
2007-09-01
影响因子：
3.2
通讯作者：
Abramson, David H.
中科院分区：
文献类型：
--
作者：
Chantada, Guillermo L.;Dunkel, Ira J.;Abramson, David H.
客观的。评估化疗失败后摘除视网膜母细胞瘤患者的结果并确定其眼外复发的危险因素。方法。三个机构的回顾性研究（1995-2002）。根据当地病理报告，病理危险因素（PRF）定义为眼前节、脉络膜、后层视神经、蛛网膜下腔或巩膜的侵犯。眼外复发被定义为事件结果。纳入 122 名患者（17 名患者双侧摘除）。化学减量包括长春新碱、卡铂和依托泊苷 (n = 80, 65.6%)、长春新碱和卡铂 (n = 17, 13.9%) 或卡铂 (n = 25, 20.5%)。 35 人还接受了外照射放射治疗（28.7%）。 PRF 包括：39 例脉络膜受累，9 例眼前节受累，9 例巩膜受累，2 例后层视神经伴蛛网膜下腔侵犯。 8 名患者（6.5%）因巩膜侵犯而接受辅助化疗。四名患者在摘除后出现眼外复发，其中两人在包括干细胞抢救在内的强化治疗后存活下来。五年无事件生存概率为 0.96。只有巩膜侵犯和双侧摘除与眼外复发显着相关。结论。化疗失败后眼球摘除后眼外复发的风险较低。接受双侧摘除术和巩膜侵犯的患者眼外复发的风险较高。
Objective. To assess the outcome and determine risk factors for extraocular relapse in patients with retinoblastoma who had been enucleated after failure of chemoreduction.Methods. Retrospective study (1995-2002) at three institutions. Pathological risk factors (PRF) were defined as invasion of the anterior segment, choroid, post-laminar optic nerve, subarachnoid space, or sclera according to the local pathology report. Extraocular relapse was defined as an event.Results. One hundred twenty-two patients were included (17 had bilateral enucleation). Chemoreduction included vincristine, carboplatin, and etoposide (n = 80, 65.6%), vincristine, and carboplatin (n = 17, 13.9%), or carboplatin (n 25, 20.5%). Thirty-five also received external beam radiotherapy (28.7%). PRF included: 39 with choroidal involvement, 9 with anterior segment, 9 with scleral, and 2 with post-laminar optic nerve with subarachnoid invasion. Adjuvant chemotherapy was given to eight patients (6.5%) because of scleral invasion. Four patients had an extraocular relapse after enucleation, two of whom survive after intensive treatment including stem cell rescue. Five-year probability of event-free survival is 0.96. Only scleral invasion and bilateral enucleation were significantly associated with extraocular relapse.Conclusions. The risk of extraocular relapse is low after enucleation following failure of chemoreduction. Patients who underwent bilateral enucleation and those with scleral invasion are at higher risk of extraocular relapse.