Not All Seeds Are Created Equal: Seed Classification Is Predictive of Outcomes in Retinoblastoma
Not All Seeds Are Created Equal: Seed Classification Is Predictive of Outcomes in Retinoblastoma
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DOI：
10.1016/j.ophtha.2017.05.034
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发表时间：
2017-12-01
期刊：
影响因子：
13.7
通讯作者：
Kim, Jonathan W.
中科院分区：
文献类型：
--
作者：
Berry, Jesse L.;Bechtold, Mercy;Kim, Jonathan W.
目的：玻璃体内化疗已成为治疗视网膜母细胞瘤玻璃体种植的重要手段。一种分类系统被描述为预测主要接受动脉内化疗的患者对玻璃体内马法兰(IVM)的反应。本研究的目的是评价静脉化疗和静脉注射作为玻璃体种植的挽救方法治疗视网膜母细胞瘤的疗效，并进一步确定玻璃体粒子分类(尘埃、球体、云雾)是否可以预测该队列中需要注射的玻璃体粒总数和注射剂量。设计：非随机回顾。研究对象：在同一中心接受静脉化疗和静脉注射的视网膜母细胞瘤患者。方法：回顾2012-2016年间接受静脉化疗和静脉注射的视网膜母细胞瘤患者的玻璃体种植情况。主要观察指标：根除玻璃体种植和挽救玻璃体种植。二次测量包括静脉注射相关的毒性和并发症。结果：总体上，纳入25名患者的28只眼，共110次静脉注射。根据种子分类，粉尘眼(n=15)平均需要注射3次，球状物(n=8)需要注射4次，云(n=5)需要注射6次。球状种子仅见于反复玻璃体播种。在28只接受治疗的眼中，9只眼摘除眼球，6只眼因视网膜疾病复发，总体抢救眼球的成功率为68%。继发于活动性视网膜母细胞瘤的抢救成功率为79%。粉尘分类是9只去眼球最常见的种植类型。玻璃体内注射后玻璃体种子100%消退，无一只眼接受放射治疗或摘除后种植。12只眼在注射后表现出3级或更大的IVM相关的视网膜或眼前节毒性。平均随访33个月(9~51个月)。结论：IVM是治疗视网膜母细胞瘤静脉化疗后玻璃体种植的有效方法。对于接受动脉内化疗的眼球，种子分类可以预测接受静脉化疗的眼球内静脉注射的总次数和剂量。有云雾的眼睛比有灰尘或球体的眼睛需要更多的注射。(C)2017年度美国眼科学会
Objective: Intravitreal chemotherapy has emerged as an important modality for treating vitreous seeding in retinoblastoma. A classification system has been described as predictive of response to intravitreal melphalan (IVM) in patients treated predominantly with primary intra-arterial chemotherapy. The objective of this study is to evaluate the outcomes of retinoblastoma treated with intravenous chemotherapy and IVM as salvage for vitreous seeding, and further to determine whether vitreous seed classification (dust, spheres, cloud) is predictive of the total number and dose of IVM injections required for treatment in this cohort.Design: A nonrandomized retrospective review.Participants: Retinoblastoma patients treated at a single center with intravenous chemotherapy and IVM.Methods: Retrospective review of patients with vitreous seeding from retinoblastoma treated with intravenous chemotherapy and IVM from 2012 to 2016.Main Outcome Measures: Primary outcome measure was eradication of seeds and globe salvage. Secondary measures included IVM-associated toxicity and complications.Results: Overall, 28 eyes of 25 patients were included, with a total of 110 IVM injections. By seed classification, eyes with dust (n = 15) required a median of 3 injections, spheres (n = 8) required 4 injections, and clouds (n = 5) required 6 injections. Spherical seeds were only seen in recurrent vitreous seeding. Of the 28 treated eyes, 9 were enucleated, 6 for recurrent retinal disease, resulting in an overall globe salvage rate of 68%. The salvage rate secondary to active retinoblastoma was 79%. Dust classification was the most prevalent seeding type of the 9 enucleated eyes. There was 100% regression of vitreous seeds after intravitreal injection and no eye was treated with radiation or enucleated for seeding. Twelve eyes demonstrated grade 3 or greater IVM-associated retinal or anterior segment toxicity post injection. Mean follow-up was 33 months (range, 9-51 months).Conclusions: IVM is an effective treatment for vitreous seeding after intravenous chemotherapy for retinoblastoma. As with eyes treated with intra-arterial chemotherapy, seed classification is predictive of the total number and dose of IVM injections in eyes treated with intravenous chemotherapy. Eyes with clouds required significantly more injections than eyes with dust or spheres. (C) 2017 by the American Academy of Ophthalmology