Evaluation of chemoprophylaxis in patients with unilateral retinoblastoma with high-risk features on histopathologic examination.
Evaluation of chemoprophylaxis in patients with unilateral retinoblastoma with high-risk features on histopathologic examination.
复制标题
DOI：
--
复制
发表时间：
2001
影响因子：
--
通讯作者：
M. Uusitalo;K. V. Quill;Ingrid U. Scott;K. Matthay;Timothy G. Murray;Joan M. O'Brien
中科院分区：
文献类型：
--
作者：
M. Uusitalo;K. V. Quill;Ingrid U. Scott;K. Matthay;Timothy G. Murray;Joan M. O'Brien
目的：通过单侧视网膜母细胞瘤患者摘除眼球的组织病理学标本，确定转移性疾病的危险因素，并评价化学预防在预防疾病传播中的价值。方法回顾了加州大学弗朗西斯科分校（1977-1998）和弗拉州迈阿密大学巴斯科姆Palmer眼科研究所（1991-1998）行原发性眼球摘除术的单侧视网膜母细胞瘤患者的病历。所有常规组织病理学标本均复查。记录肿瘤侵入视神经或眼外膜的程度和处方的化学预防方案。这项回顾性研究包括129名患者，平均随访时间为54个月。3例肿瘤侵犯巩膜。82例患者视神经不同程度受累，其中11例肿瘤侵犯筛板。另外4例患者涉及视神经的手术切缘。43例患者的脉络膜受累，12例患者被认为受到严重影响。10例患者观察到眼前节受累。对4例在视神经手术切缘有肿瘤细胞的患者中的4例和11例椎板后疾病患者中的7例进行了核摘除后化学预防，所有患者的椎板后肿瘤延伸至少为1 mm。分别对3/4和1/11例患者进行了外照射放疗。脉络膜或前房受累的患者不接受化学预防，除非视神经也累及筛板以外。1例肿瘤延伸至视神经手术切缘的患者死于转移性疾病。结论：对于肿瘤延伸至视神经手术切缘的患者，化学预防是必要的，并且可能有利于预防肿瘤延伸至筛板以外的患者的转移。我们没有对患有层前视神经疾病或孤立性脉络膜受累的患者提供药物预防，这些患者仍然没有播散性疾病。
OBJECTIVES To identify risk factors for metastatic disease on histopathologic specimens of enucleated eyes from patients with unilateral retinoblastoma, and to evaluate the value of chemoprophylaxis in preventing disease dissemination. METHODS Medical records from patients with unilateral retinoblastoma who underwent primary enucleation were reviewed at the University of California, San Francisco (1977-1998) and Bascom Palmer Eye Institute, University of Miami, Miami, Fla (1991-1998). All routine histopathologic specimens were reexamined. The extent of tumor invasion into the optic nerve or ocular coats and the prescribed chemoprophylactic regimen were recorded. RESULTS This retrospective study included 129 patients followed for a median of 54 months. Three patients had tumor invading the sclera. The optic nerve was involved to some extent in 82 patients, 11 of whom had tumor extension beyond the lamina cribrosa. The surgical margin of the optic nerve was involved in an additional 4 patients. The choroid was involved in 43 patients, and was considered massively affected in 12 patients. Anterior segment involvement was observed in 10 patients. Postenucleation chemoprophylaxis was administered to 4 of 4 patients who had tumor cells at the surgical margin of the optic nerve and to 7 of 11 patients with postlaminar disease, all of whom had at least 1 mm of postlaminar tumor extension. External beam radiotherapy was administered to 3/4 and 1/11 of these patients, respectively. Chemoprophylaxis was not administered to patients with choroidal or anterior chamber involvement unless the optic nerve was also involved beyond the lamina cribrosa. One patient with tumor extending to the surgical margin of the optic nerve died of metastatic disease. CONCLUSIONS Chemoprophylaxis is necessary for patients with tumor extending to the surgical margin of the optic nerve and is likely to be beneficial in preventing metastases in patients with tumor extending beyond the lamina cribrosa. We did not offer chemoprophylaxis to patients with prelaminar optic nerve disease or isolated choroidal involvement, and these patients remained free of disseminated disease.