Shields C L, Shields J A, De Potter P
Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania 19107, USA.
Curr Opin Ophthalmol. 1996 Jun;7(3):20-6. doi: 10.1097/00055735-199606000-00004.
The management of retinoblastoma has evolved tremendously for the past century, and recently there is a trend toward focal conservative treatments. This trend is due primarily to the earlier detection of the disease when the tumors are in a smaller stage of development as well as to advanced, more focused treatment modalities. Enucleation is still used for advanced retinoblastoma, especially when there is a concern that there may be invasion of the optic nerve, choroid, or orbit. The hydroxyapatite implant has provided improved cosmetic rehabilitation of the socket after enucleation. External-beam radiotherapy continues to be an important method of treating advanced retinoblastoma, especially when there is diffuse vitreous seeding. Plaque radiotherapy is a useful tool for controlling medium or small retinoblastomas, especially tumors with focal vitreous seeding or those that recur after other methods have failed. Cryotherapy and photocoagulation provide excellent control of small tumors, and advanced laser delivery systems have improved the visualization and ease of treatment of retinoblastoma. Thermotherapy and chemothermotherapy are the newest focal methods that are showing promising results for small to medium-sized retinoblastoma. Recent developments with chemotherapy regimens have allowed dramatic control of intraocular retinoblastoma, and they play an important role in the initial management of many cases.
在过去的一个世纪里，视网膜母细胞瘤的治疗方法有了巨大的发展，最近出现了一种局部保守治疗的趋势。这种趋势主要是由于疾病在肿瘤处于较小发展阶段时能更早被发现，以及先进、更有针对性的治疗方式。眼球摘除术仍用于晚期视网膜母细胞瘤，特别是当担心可能存在视神经、脉络膜或眼眶受侵时。羟基磷灰石植入物在眼球摘除术后改善了眼窝的美容修复。外照射放疗仍然是治疗晚期视网膜母细胞瘤的重要方法，特别是当存在弥漫性玻璃体种植时。敷贴放疗是控制中、小型视网膜母细胞瘤的有用工具，特别是对于有局限性玻璃体种植的肿瘤或其他方法治疗失败后复发的肿瘤。冷冻疗法和光凝疗法能很好地控制小肿瘤，先进的激光输送系统改善了视网膜母细胞瘤的可视化和治疗的便利性。温热疗法和化疗热疗是最新的局部治疗方法，对中小型视网膜母细胞瘤显示出有希望的结果。化疗方案的最新进展已能显著控制眼内视网膜母细胞瘤，并且它们在许多病例的初始治疗中发挥着重要作用。
