Uusitalo M S, Van Quill K R, Scott I U, Matthay K K, Murray T G, O'Brien J M
Division of Ocular Oncology, Department of Ophthalmology, University of California, San Francisco, 10 Kirkham St, San Francisco, CA 94143-0730.
Arch Ophthalmol. 2001 Jan;119(1):41-8.
To identify risk factors for metastatic disease on histopathologic specimens of enucleated eyes from patients with unilateral retinoblastoma, and to evaluate the value of chemoprophylaxis in preventing disease dissemination.
Medical records from patients with unilateral retinoblastoma who underwent primary enucleation were reviewed at the University of California, San Francisco (1977-1998) and Bascom Palmer Eye Institute, University of Miami, Miami, Fla (1991-1998). All routine histopathologic specimens were reexamined. The extent of tumor invasion into the optic nerve or ocular coats and the prescribed chemoprophylactic regimen were recorded.
This retrospective study included 129 patients followed for a median of 54 months. Three patients had tumor invading the sclera. The optic nerve was involved to some extent in 82 patients, 11 of whom had tumor extension beyond the lamina cribrosa. The surgical margin of the optic nerve was involved in an additional 4 patients. The choroid was involved in 43 patients, and was considered massively affected in 12 patients. Anterior segment involvement was observed in 10 patients. Postenucleation chemoprophylaxis was administered to 4 of 4 patients who had tumor cells at the surgical margin of the optic nerve and to 7 of 11 patients with postlaminar disease, all of whom had at least 1 mm of postlaminar tumor extension. External beam radiotherapy was administered to 3/4 and 1/11 of these patients, respectively. Chemoprophylaxis was not administered to patients with choroidal or anterior chamber involvement unless the optic nerve was also involved beyond the lamina cribrosa. One patient with tumor extending to the surgical margin of the optic nerve died of metastatic disease.
Chemoprophylaxis is necessary for patients with tumor extending to the surgical margin of the optic nerve and is likely to be beneficial in preventing metastases in patients with tumor extending beyond the lamina cribrosa. We did not offer chemoprophylaxis to patients with prelaminar optic nerve disease or isolated choroidal involvement, and these patients remained free of disseminated disease.
确定单侧视网膜母细胞瘤患者眼球摘除术后病理标本上发生转移性疾病的危险因素，并评估化学预防在预防疾病播散方面的价值。
回顾了加利福尼亚大学旧金山分校（1977 - 1998年）和佛罗里达州迈阿密市迈阿密大学巴斯科姆·帕尔默眼科研究所（1991 - 1998年）接受初次眼球摘除术的单侧视网膜母细胞瘤患者的病历。所有常规病理标本均重新检查。记录肿瘤侵犯视神经或眼球壁的程度以及规定的化学预防方案。
这项回顾性研究纳入了129例患者，中位随访时间为54个月。3例患者肿瘤侵犯巩膜。82例患者的视神经有不同程度受累，其中11例肿瘤延伸至筛板后。另有4例患者视神经手术切缘受累。脉络膜受累43例，其中12例被认为受累严重。10例患者眼前段受累。4例视神经手术切缘有肿瘤细胞的患者中有4例接受了眼球摘除术后化学预防，11例筛板后疾病患者中有7例接受了化学预防，所有这些患者筛板后肿瘤延伸至少1毫米。这些患者中分别有3/4和1/11接受了外照射放疗。除非视神经筛板后也受累，否则脉络膜或前房受累患者不接受化学预防。1例肿瘤延伸至视神经手术切缘的患者死于转移性疾病。
对于肿瘤延伸至视神经手术切缘的患者，化学预防是必要的，并且可能有助于预防肿瘤延伸至筛板后的患者发生转移。对于筛板前视神经疾病或孤立脉络膜受累的患者，我们未提供化学预防，这些患者未发生播散性疾病。
