Retinoblastoma: evidence for postenucleation adjuvant chemotherapy.
Retinoblastoma: evidence for postenucleation adjuvant chemotherapy.
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DOI：
10.1097/iio.0000000000000048
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发表时间：
2015-01-01
影响因子：
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通讯作者：
Kim, Jonathan W
中科院分区：
文献类型：
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作者：
Kim, Jonathan W
在美国，眼内视网膜母细胞瘤患者摘除后的治愈率在 96% 至 100% 之间。 1-3 然而，当眼球摘除后确实发生眼外复发时，死亡率很高。 1, 4 已有大量回顾性研究试图确定哪些患者在摘除术后发生转移性疾病的风险最高。 5-18 人们普遍认为组织病理学危险因素比临床特征更具预测性。 12, 14, 16, 17 通过识别与复发风险增加相关的“高风险”组织病理学特征，临床医生提出可以通过预防性治疗来预防转移。对摘除后没有明显转移性疾病证据的儿童进行全身化疗称为化学预防或辅助治疗。选择辅助治疗候选者是视网膜母细胞瘤治疗中最具争议的领域之一，因为对于哪些组织病理学特征符合化学预防标准几乎没有达成共识。在回顾现有文献时，存在许多使转移风险的准确评估复杂化的问题，包括复发患者数量少、纳入单侧和双侧患者、缺乏对照研究、纳入未经治疗和治疗的患者以及不同研究者对组织病理学风险因素的不同定义。文献中，任何这些组织病理学特征（称为“高风险”因素）摘除术后复发的风险范围为 0% 至 81%。 5–8, 10–14, 16, 17, 19, 20 相反，没有任何高风险特征的摘除患者也可能出现眼眶和全身复发。 2, 16 人们普遍认为，视神经切缘阳性的患者应接受辅助治疗，通常采用全身化疗和眼眶放疗。 6, 8, 11, 16 巩膜侵犯应接受以下治疗也达成了近乎完全的共识：
In the United States, cure rates after enucleation for patients with intraocular retinoblastoma range between 96% and 100%. 1–3 However, when extraocular relapse does occur after enucleation, mortality rates are high. 1, 4 There have been numerous retrospective studies attempting to identify which patients are at highest risk for metastatic disease after enucleation. 5–18 It is generally accepted that histopathologic risk factors are more predictive than clinical features. 12, 14, 16, 17 By identifying ‘‘highrisk’’histopathologic features that are associated with an increased risk of relapse, clinicians have proposed that metastasis may be prevented with prophylactic treatment. Systemic chemotherapy given to children after enucleation without evidence of overt metastatic disease is termed chemoprophylaxis or adjuvant treatment. Selecting candidates for adjuvant treatment represents one of the most controversial areas of retinoblastoma management, as there is little consensus on which histopathologic features meet the criteria for chemoprophylaxis. When reviewing the available literature, there are numerous issues that complicate an accurate assessment of the metastatic risk, including the low numbers of patients with relapse, inclusion of unilateral and bilateral patients, absence of controlled studies, inclusion of untreated and treated patients, and different definitions for histopathologic risk factors used by various investigators.The risk of relapse following enucleation for any of these histopathologic features, termed ‘‘high-risk’’factors, ranges anywhere from 0% to 81% in the literature. 5–8, 10–14, 16, 17, 19, 20 Conversely, enucleated patients without any high-risk features can also develop orbital and systemic relapse. 2, 16 There is general consensus that patients with a positive optic nerve margin should receive adjuvant therapy, typically with both systemic chemotherapy and orbital radiation. 6, 8, 11, 16 There is also nearcomplete consensus that scleral invasion should receive treatment with