Success of Intra-arterial Chemotherapy (Chemosurgery) for Retinoblastoma Effect of Orbitovascular Anatomy
Success of Intra-arterial Chemotherapy (Chemosurgery) for Retinoblastoma Effect of Orbitovascular Anatomy
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DOI：
10.1001/archophthalmol.2011.386
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发表时间：
2012-02-01
影响因子：
--
通讯作者：
Abramson, David H.
中科院分区：
文献类型：
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作者：
Marr, Brian P.;Hung, Crystal;Abramson, David H.
目的：回顾在治疗视网膜母细胞瘤的动脉内化疗（化疗）期间进行的眼眶血管造影结果，以评估眼眶血管解剖结构的血管造影变异性与肿瘤反应和结果的关系。方法：回顾了 56 名接受盐酸美法仑、盐酸托泊替康或卡铂联合化疗的视网膜母细胞瘤儿科患者的医疗记录和 64 份眼眶血管造影照片。对主要眼眶动脉和毛细血管红红模式进行分级，并使用对数秩和 Fisher 精确检验比较肿瘤反应和复发。结果：肿瘤反应的统计学显着变量是泪动脉突出 (P=.001)、既往治疗 (P=.003) 和泪腺红红 (P=.004)。玻璃体种子反应唯一具有统计显着性的变量是睫状体红晕 (P=.03)。影响复发时间和摘除时间的统计学显着变量分别是脉络膜红晕缺失 (P=.01) 和泪动脉存在 (P=.03)。 结论：动脉内化疗的成功取决于通过眼动脉将药物输送到眼内的目标肿瘤。由于所用药物量小（每次治疗 0.50-1.25 mL）和导管插入术的选择性，影响眼眶血流的变量极大地影响药物输送和化疗的成功。
Objectives: To review results of orbital angiography performed during intra-arterial chemotherapy (chemosurgery) for treatment of retinoblastoma to assess the association of angiographic variability in orbitovascular anatomy with tumor response and outcomes.Methods: Medical records and 64 orbital angiograms were reviewed for 56 pediatric patients with retinoblastoma undergoing chemosurgery using a combination of melphalan hydrochloride, topotecan hydrochloride, or carboplatin. The major orbital arteries and capillary blush patterns were graded, and tumor response and recurrence were compared using the log-rank and Fisher exact tests.Results: Statistically significant variables for tumor response were lacrimal artery prominence (P=.001), previous treatment (P=.003), and lacrimal blush (P=.004). The only statistically significant variable for vitreous seed response was ciliary body blush (P=.03). Statistically significant variables influencing time to recurrence and time to enucleation were choroidal blush absence (P=.01) and lacrimal artery presence (P=.03), respectively.Conclusions: The success of intra-arterial chemotherapy is dependent on delivery of drug to the target tumor within the eye via the ophthalmic artery. Because of the small volume of drug used (0.50-1.25 mL per treatment) and the selectivity of catheterization, variables affecting orbital blood flow greatly influence drug delivery and the success of chemosurgery.