Simultaneous Bilateral Ophthalmic Artery Chemosurgery for Bilateral Retinoblastoma (Tandem Therapy)
Simultaneous Bilateral Ophthalmic Artery Chemosurgery for Bilateral Retinoblastoma (Tandem Therapy)
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DOI：
10.1371/journal.pone.0156806
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发表时间：
2016-06-03
期刊：
影响因子：
3.7
通讯作者：
Gobin, Y. Pierre
中科院分区：
文献类型：
--
作者：
Abramson, David H.;Marr, Brian P.;Gobin, Y. Pierre
目的总结双侧眼动脉化疗治疗双侧视网膜母细胞瘤的7年经验。设计回顾性、单机构研究。对象：自2008年3月以来治疗的60例双侧视网膜母细胞瘤患儿120眼。方法回顾性分析所有在Memorial Sloan Kettering接受双侧眼动脉化疗（Melphalan, Carboplatin, Topotecan, Methotrexate）的患儿，这些患儿在相同的初始疗程中接受了双侧眼动脉化疗（Melphalan, Carboplatin, Topotecan, Methotrexate）。主要观察指标：眼部生存、转移性疾病、转移性患者生存、第二次肿瘤、全身不良反应、血液制品输注需求、治疗前后视网膜电图。结果抢救116只眼（4只眼去核，3只因病情进展，1只家庭选择）。Kaplan Meier眼生存率为1年99.2%，2年和3年96.9%，4至7年94.9%。无转移性疾病或转移性死亡病例，平均随访3.01年。两个孩子患上了第二种癌症（都是松果体母细胞瘤），其中一个死亡。需要输血制品3例（4次），占1.9%。2名儿童出现发热/中性粒细胞减少需要住院治疗（0.95%）。21.6%的患者ERGs改善，52.5%的患者治疗后ERGs不变（增减幅度小于25 μ V）。结论双侧眼动脉化疗是一种安全有效的治疗双侧视网膜母细胞瘤的方法，即使双侧眼睛已经进展，或者双眼在全身化疗后仍有进展。眼生存率极好（8年时为94.9%），无转移性疾病病例，无转移性疾病死亡，但儿童仍有发生第二种癌症的风险。21.6%的病例ERG功能改善。尽管在同一疗程中使用了双眼化疗，但全身毒性很低。
ObjectiveReport on the 7-year experience with bilateral ophthalmic artery chemosurgery (OAC-Tandem therapy) for bilateral retinoblastoma.DesignRetrospective, single institution study.Subjects120 eyes of 60 children with bilateral retinoblastoma treated since March 2008.MethodsRetrospective review of all children treated at Memorial Sloan Kettering with bilateral ophthalmic artery chemosurgery (Melphalan, Carboplatin, Topotecan, Methotrexate) delivered in the same initial session to both naive and previously treated eyes.Main Outcome MeasuresOcular survival, metastatic disease, patient survival from metastases, second cancers, systemic adverse effects, need for transfusion of blood products, electroretinogram before and after treatment.Results116 eyes were salvaged (4 eyes were enucleated: 3 because of progressive disease, 1 family choice). Kaplan Meier ocular survival was 99.2% at one year, 96.9% at 2 and 3 years and 94.9% for years 4 through 7. There were no cases of metastatic disease or metastatic deaths with a mean follow-up of 3.01 years. Two children developed second cancers (both pineoblastoma) and one of them died. Transfusion of blood products was required in 3 cases (4 transfusions), 1.9%. Two children developed fever/neutropenia requiring hospitalization (0.95%). ERGs were improved in 21.6% and unchanged after treatment in 52.5% of cases (increase or decrease of less than 25 mu V).ConclusionsBilateral ophthalmic artery chemosurgery is a safe and effective technique for managing bilateral retinoblastoma-even when eyes are advanced bilaterally, and if both eyes have progressed after systemic chemotherapy. Ocular survival was excellent (94.9% at 8 years), there were no cases of of metastatic disease and no deaths from metastatic disease, but children remain at risk for second cancers. In 21.6% of cases ERG function improved. Despite using chemotherapy in both eyes in the same session, systemic toxicity was low.