Unilateral Retinoblastoma Managed With Intravenous Chemotherapy Versus Intra-Arterial Chemotherapy. Outcomes Based on the International Classification of Retinoblastoma
Unilateral Retinoblastoma Managed With Intravenous Chemotherapy Versus Intra-Arterial Chemotherapy. Outcomes Based on the International Classification of Retinoblastoma
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DOI：
10.1097/apo.0000000000000172
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发表时间：
2016-03-01
影响因子：
4.4
通讯作者：
Shields, Jerry A.
中科院分区：
文献类型：
--
作者：
Shields, Carol L.;Jorge, Rodrigo;Shields, Jerry A.
目的：本研究的目的是比较静脉化疗（IVC）和动脉化疗（IAC）治疗单侧视网膜母细胞瘤的结果。设计：回顾性比较介入病例系列。方法：对使用长春新碱、依托泊苷和卡铂进行IVC治疗的单侧视网膜母细胞瘤患者或使用美法兰加或不加拓扑替康的IAC患者进行至少1年的随访比较。主要结局指标为全球挽救。结果：91例单侧视网膜母细胞瘤患者中，42例（46%）采用IVC， 49例（54%）采用IAC。通过比较（IVC与IAC）， IAC组患者的平均肿瘤直径（14 vs 18 mm, P < 0.001）和厚度（7 vs 10 mm, P = 0.001）更大，玻璃体种子活跃的百分比（29% vs 55%, P = 0.01）更大，视网膜脱离（10% vs 43%, P < 0.001）。两组均无A组病例。B组、C组和E组的球体挽回率无显著差异，但pd组IAC显著改善了球体挽回率（48% vs 91%, P = 0.004）。IAC治疗实体瘤（62% vs 92%, P = 0.002）、视网膜下种子（31% vs 86%, P = 0.006）和玻璃体种子（25% vs 74%, P = 0.006）的对照明显更好。两组均无患者发生松果体母细胞瘤、第二癌、转移或死亡。结论：对于单侧视网膜母细胞瘤，与IVC相比，IAC提供了明显更好的眼球保留。此外，IAC对实体瘤、视网膜下种子和玻璃体种子提供了明显更好的控制。
Purpose: The objective of this study was to compare outcomes after intravenous chemotherapy (IVC) versus intra-arterial chemotherapy (IAC) for unilateral retinoblastoma.Design: A retrospective comparative interventional case series.Methods: Patients with unilateral retinoblastoma managed with either IVC using vincristine, etoposide, and carboplatin or IAC using melphalan with or without topotecan with a minimum of 1-year follow-up were compared. The primary outcome measure was globe salvage.Results: Of 91 patients with unilateral retinoblastoma, IVC was employed in 42 (46%) cases and IAC in 49 (54%). By comparison (IVC vs IAC), patients in the IAC group had greater mean tumor diameter (14 vs 18 mm, P < 0.001) and thickness (7 vs 10 mm, P = 0.001), greater percentage-with active vitreous seeds (29% vs 55%, P = 0.01), and greater total retinal detachment (10% vs 43%, P < 0.001). There were no cases of group A in either treatment arm. Globe salvage was not significantly different in groups B, C, or E, but there was significantly improved globe salvage with IAC for groupD (48% vs 91%, P = 0.004). Control was significantly better with IAC for solid tumor (62% vs 92%, P = 0.002), subretinal seeds (31% vs 86%, P = 0.006), and vitreous seeds (25% vs 74%, P = 0.006). There were no patients with pinealoblastoma, second cancer, metastasis, or death in either group.Conclusions: For unilateral retinoblastoma, IAC provided significantly superior globe salvage compared with IVC for group D eyes. In addition, IAC provided significantly superior control for solid tumor, subretinal seeds, and vitreous seeds.