Current Treatment of Bilateral Retinoblastoma: The Impact of Intraarterial and Intravitreous Chemotherapy.
Current Treatment of Bilateral Retinoblastoma: The Impact of Intraarterial and Intravitreous Chemotherapy.
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DOI：
10.1016/j.neo.2018.05.007
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发表时间：
2018-08
期刊：
影响因子：
--
通讯作者：
Abramson DH
中科院分区：
文献类型：
--
作者：
Francis JH;Roosipu N;Levin AM;Brodie SE;Dunkel IJ;Gobin YP;Abramson DH
目的：评估眼动脉化疗 (OAC) 和玻璃体内化疗时代在单中心治疗的初治双侧视网膜母细胞瘤 5 年的治疗和结果。方法：对 2012 年 1 月至 2017 年 2 月期间在纪念斯隆·凯特琳癌症中心接受治疗的 46 例（92 眼）幼稚双侧视网膜母细胞瘤患者进行回顾性队列研究。采用间接检眼镜、眼底照相、超声检查和超声生物显微镜检查来评估临床反应。通过 Kaplan-Meier 估计来评估患者的眼部生存率、眼部无进展生存率、眼部无复发事件生存率和第二眼生存率。通过视网膜电图评估视网膜毒性。记录斯内伦视力和全血细胞计数指标。结果：41 名患者 (89%) 的 64 只眼睛 (70%) 接受了眼动脉化疗作为治疗的一部分。 26 名患者 (56%) 接受串联 OAC（双侧同时输注）。七只眼睛主要被摘除。没有接受初始 OAC 的眼睛被摘除。最初接受局部治疗的一只眼睛出现了一次继发性摘除，并伴有前房复发。 Kaplan-Meier 对整体眼部、继发性眼部（复发治疗后的生存率）、无进展和无复发事件生存率的 3 年估计分别为 91.3% [95% 置信区间 (CI) 83.4-95.5]、98.7% (95% CI 91.3-99.8)、91.5% (95% CI 83.0-95.8) 和分别为 78.9% (95% CI 68.2-86.3)。国际视网膜母细胞瘤分类 (ICRB) A-C 组的总体和继发性眼部存活率为 100%。 ICRB D 组的总眼部生存率为 91.5% (95% CI 70-97.8)，E 组为 71.4% (95% CI 47.1-79.4)。ICRB D 组的继发性眼部生存率为 95.4% (95% CI 71.8-99.3)，E 组为 100%。没有与治疗相关的死亡，三名患者发生三侧视网膜母细胞瘤（一名患者死亡），一名患者（未接受 OAC）出现转移性疾病，并在 32 个月的随访中处于缓解状态。结论：当今时代和该中心的大多数（89%）双侧视网膜母细胞瘤患者均接受了 OAC 治疗。这拯救了历史数量的眼睛。四分之一的眼睛出现复发性疾病（定义为需要任何治疗（包括局灶性治疗）的复发性疾病），其中大多数发生在治疗后的第一年，除了一只眼睛外，所有眼睛都得到了挽救。患者的生存没有受到任何影响。
PURPOSE: To evaluate the management and outcomes of naïve bilateral retinoblastoma treated at a single-center over a 5-year period during the era of ophthalmic artery chemosurgery (OAC) and intravitreous chemotherapy. METHODS: Retrospective cohort study of 46 patients (92 eyes) with naïve bilateral retinoblastoma treated at Memorial Sloan Kettering Cancer Center between January 2012 and February 2017. Indirect ophthalmoscopy, fundus photography, ultrasonography, and ultrasonic biomicroscopy were used to evaluate clinical response. Patient, ocular, ocular progression-free, ocular recurrent event–free, and second ocular survivals were assessed by Kaplan-Meier estimates. Retinal toxicity was evaluated by electroretinography. Snellen visual acuity and complete blood count metrics were recorded. RESULTS: Sixty-four eyes (70%) in 41 patients (89%) received ophthalmic artery chemosurgery as part of their treatment. Twenty-six patients (56%) received tandem OAC (bilateral simultaneous infusions). Seven eyes were primarily enucleated. No eye receiving initial OAC was enucleated. There was a single secondary enucleation in an eye initially treated with focal therapy with anterior chamber recurrence. The 3-year Kaplan-Meier estimates for overall ocular, secondary ocular (survival after treatment for recurrence), progression-free, and recurrent event–free survival were 91.3% [95% confidence interval (CI) 83.4-95.5], 98.7% (95% CI 91.3-99.8), 91.5% (95% CI 83.0-95.8), and 78.9% (95% CI 68.2-86.3), respectively. Overall and secondary ocular survivals were 100% for International Classification of Retinoblastoma (ICRB) groups A-C. Overall ocular survival was 91.5% (95% CI 70-97.8) for ICRB group D and 71.4% (95% CI 47.1-79.4) for group E. Secondary ocular survival was 95.4% (95% CI 71.8-99.3) for ICRB group D and 100% for group E. There were no treatment-related deaths, three patients developed trilateral retinoblastoma (one died), and one patient (who did not receive OAC) developed metastatic disease and is in remission at 32-month follow-up. CONCLUSION: The majority (89%) of bilateral retinoblastoma patients in the current era and at this center were treated with OAC. This has resulted in saving a historic number of eyes. A quarter of eyes developed recurrent disease (defined as recurrent disease requiring any treatment including focal), the majority of which occurred in the first year after treatment, and all but one was saved. There has been no compromise in patient survival.
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DOI：
10.1016/0360-3016(80)90221-7
发表时间：
1980-01-01
影响因子：
7
作者：
GAGNON, JD;WARE, CM;STEVENS, KR
通讯作者：
STEVENS, KR
影响因子：
1.2
作者：
Sohajda, Z;Damjanovich, J;Kiss, C
通讯作者：
Kiss, C
影响因子：
3.7
作者：
Francis JH;Levin AM;Zabor EC;Gobin YP;Abramson DH
通讯作者：
Abramson DH
影响因子：
13.7
作者：
Francis, Jasmine H.;Schaiquevich, Paula;Abramson, David H.
通讯作者：
Abramson, David H.
影响因子：
3.7
作者：
Abramson, David H.;Marr, Brian P.;Gobin, Y. Pierre
通讯作者：
Gobin, Y. Pierre