Minimal Exposure (One or Two Cycles) of Intra-arterial Chemotherapy in the Management of Retinoblastoma
Minimal Exposure (One or Two Cycles) of Intra-arterial Chemotherapy in the Management of Retinoblastoma
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DOI：
10.1016/j.ophtha.2011.06.036
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发表时间：
2012-01-01
期刊：
影响因子：
13.7
通讯作者：
Shields, Jerry A.
中科院分区：
文献类型：
--
作者：
Shields, Carol L.;Kaliki, Swathi;Shields, Jerry A.
目的：评价动脉内化疗（IAC）治疗视网膜母细胞瘤少于3周期的疗效。设计：回顾性、非随机、干预性病例系列。参与者：8例患者。干预：动脉内化疗。主要观察指标：肿瘤控制和球体保留。结果：8例视网膜母细胞瘤患者接受IAC治疗少于3个周期，原因是肿瘤得到完全控制，无残余存活肿瘤（n = 7）或反应较差（n = 1），患者进一步治疗的希望渺茫。在3例中，额外的血管损害阻止了进一步的IAC。6例为原发性治疗，2例为其他治疗失败后继发治疗。8只眼按照国际视网膜母细胞瘤分类法分为C组（n = 2）、D组（n = 3）、E组（n = 1）和二次治疗组（n = 2）。初步检查时，主要肿瘤显示平均基底直径16 mm，厚度8.6 mm，玻璃体种子（n = 2），视网膜下种子（n = 6），虹膜新生血管（n = 1）。3例患者采用单周期IAC治疗，5例患者采用2周期IAC治疗。IAC术后肿瘤完全缓解7眼（88%），部分缓解1眼（13%）。在平均13个月的随访中，视网膜内肿瘤复发（n = 1），视网膜下种子复发（n = 1），无玻璃体种子复发。2只C组眼中2只（100%）、3只D组眼中3只（100%）、1只E组眼中0只（0%）、2只二次治疗眼中1只（50%）实现球体恢复。8只眼中有6只（75%）的眼球得以保留，8只眼中有2只（25%）需要摘除眼球。结论：对于C组或D组视网膜母细胞瘤患者，1 ~ 2个周期的IAC治疗足够，肿瘤控制效果显著。财务披露：作者在本文中讨论的任何材料中没有专有或商业利益。眼科2012;119:188-192 (C) 2012由美国眼科学会。
Purpose: To assess the efficacy of less than 3 cycles of intra-arterial chemotherapy (IAC) for retinoblastoma.Design: Retrospective, nonrandomized, interventional case series.Participants: Eight patients.Intervention: Intra-arterial chemotherapy.Main Outcome Measures: Tumor control and globe salvage.Results: Eight patients received fewer than 3 cycles of IAC for retinoblastoma because there was complete tumor control with no residual viable tumor (n = 7) or poor response (n = 1) with little hope that further therapy would benefit the patient. In 3 cases, additional vascular compromise precluded further IAC. The treatment was primary in 6 cases and secondary after failure of other treatment in 2 cases. The 8 eyes were classified (International Classification of Retinoblastoma) as group C (n = 2), group D (n = 3), group E (n = 1), and secondary treatment (n = 2). At initial examination, the main tumor showed a mean basal diameter of 16 mm, a thickness of 8.6 mm, vitreous seeds (n = 2), subretinal seeds (n = 6), and iris neovascularization (n = 1). Three patients were treated with a single cycle of IAC, and 5 patients were treated with 2 cycles of IAC. After IAC, complete tumor response was found in 7 eyes (88%) and partial response was found in 1 eye (13%). Over a mean of 13 months follow-up, there was intraretinal tumor recurrence (n = 1), subretinal seed recurrence (n = 1), and no case of vitreous seed recurrence. Globe salvage was achieved in 2 of 2 group C eyes (100%), 3 of 3 group D eyes (100%), 0 of 1 group E eye (0%), and 1 of 2 secondary treatment eyes (50%). Globe salvage was achieved in 6 of 8 eyes (75%), and 2 of 8 eyes (25%) required enucleation.Conclusions: One or 2 cycles of IAC can be sufficient for selected eyes with group C or D retinoblastoma, with remarkable tumor control.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2012;119:188-192 (C) 2012 by the American Academy of Ophthalmology.