Combined, sequential intravenous and intra-arterial chemotherapy (bridge chemotherapy) for young infants with retinoblastoma.
Combined, sequential intravenous and intra-arterial chemotherapy (bridge chemotherapy) for young infants with retinoblastoma.
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DOI：
10.1371/journal.pone.0044322
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Abramson DH
中科院分区：
文献类型：
--
作者：
Gobin YP;Dunkel IJ;Marr BP;Francis JH;Brodie SE;Abramson DH
动脉内（IA）化疗在新生儿和小婴儿中具有更高的手术并发症风险。由于这些原因，我们开发了一种桥接静脉单药化疗的策略，以推迟这些儿童的IA化疗。需要化疗的视网膜母细胞瘤新生儿和幼儿接受全身卡铂化疗（18.7 mg/kg IV，每3-4周一次），直到他们达到3个月大，体重达到6 Kg。如有必要，随后每隔4周进行IA化疗。通过眼科检查的肿瘤消退来判断疗效。视网膜电图检查判断视网膜毒性。11名儿童（19只眼）接受了治疗。所有患者均存活，无患者发生转移性疾病或继发恶性肿瘤（平均随访27个月，范围9-46个月）。所有患儿均接受静脉卡铂（中位2个周期，范围1-5）联合冷冻和激光治疗。这对5只眼睛有效，不需要IA化疗。14只眼接受IA化疗（中位数3.5个周期/眼，范围1 - 6）。不需要放射治疗。Kaplan Meier估计的1年眼部无辐射生存率为94.7%（95%置信区间为68.1-99.2%）。由于肿瘤进展，一只眼睛被摘除。ERG显示视网膜功能无恶化。Bridge IV-IA化疗是可行和安全的，是治疗新生儿和幼儿视网膜母细胞瘤的一种有前途的策略。
Intra-arterial (IA) chemotherapy has more risks of procedural complications in neonates and young infants. For these reasons, we have developed a strategy of bridge intravenous single agent chemotherapy to postpone IA chemotherapy in these children Neonates and young infants with retinoblastoma who required chemotherapy were treated with systemic carboplatin chemotherapy (18.7 mg/kg IV every 3–4 weeks) until they reached the age of 3 months and a weight of 6 Kg. If necessary, IA chemotherapy was subsequently performed at 4 weeks intervals. Efficacy was judged by tumor regression on ophthalmological examination. Retinal toxicity was judged by electroretinography. Eleven children (19 eyes) were treated. All patients are alive and no patient has developed metastatic disease or second malignancies (mean follow-up 27 months, range 9–46 months). Intravenous carboplatin (median 2 cycles, range 1–5) combined with cryotherapy and laser was given to all children. This was effective for five eyes, which did not require IA chemotherapy. IA chemotherapy was administered to 14 eyes (median 3.5 cycles per eye, range 1 to 6). No radiation therapy was required. The Kaplan Meier estimate of ocular radiation-free survival was 94.7% at one year (95% confidence interval 68.1–99.2%). One eye was enucleated due to tumor progression. ERG showed no deterioration of retinal function. Bridge IV-IA chemotherapy was feasible and safe, and is a promising strategy to treat retinoblastoma in neonates and young infants.