Brichard Bénédicte, De Bruycker Jean Jacques, De Potter Patrick, Neven Bénédicte, Vermylen Christiane, Cornu Guy
Department of Pediatric Hematology and Oncology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium.
Med Pediatr Oncol. 2002 Jun;38(6):411-5. doi: 10.1002/mpo.1355.
To assess the efficacy of chemotherapy (chemoreduction) plus local treatments as an alternative to external beam and enucleation for intraocular retinoblastoma.
A prospective study was performed on 21 patients with retinoblastoma treated in our institution from September 1997 to December 2000 to study the ocular outcome of those 33 eyes.
There were 9 unilateral and 12 bilateral retinoblastoma cases. There were 12 eyes with Reese-Ellsworth group I-IV and 21 eyes with group V. Among 33 eyes, nine eyes (27%) were initially managed by enucleation. The remaining 24 eyes (73%) were initially treated with chemoreduction (maximum of six cycles of carboplatin, vincristine, etoposide) or chemothermotherapy. Among those 24 eyes, 20 were successfully treated with local treatments (thermotherapy plus cryotherapy in 16 eyes and thermotherapy plus cryotherapy plus (125)I plaque radiotherapy in 4 eyes), enucleation eventually underwent in two eyes and was proposed but refused in one child with bilateral group V retinoblastoma. With a median follow-up of 21 months, conservative management without external beam radiation was successful in all 12 eyes with group I-IV and in a total of 20/33 eyes (60%). Among the nine cases of unilateral retinoblastoma, eight were enucleated but among the 24 eyes with bilateral retinoblastoma, 19 (79%) were successfully treated with conservative therapy.
It may be possible to eradicate viable tumor in all eyes with Reese-Ellsworth group I-IV retinoblastoma by chemoreduction followed by local treatments. Although 8 out of 21 eyes (38%) with group V retinoblastoma may be salvaged after chemoreduction and local therapies, enucleation remained the treatment of choice in those eyes with total retinal detachment and diffuse vitreous seeding.
评估化疗（减瘤化疗）联合局部治疗作为眼内视网膜母细胞瘤外照射和眼球摘除术替代方案的疗效。
对1997年9月至2000年12月在我院接受治疗的21例视网膜母细胞瘤患者进行前瞻性研究，以研究这33只眼的眼部结局。
有9例单侧视网膜母细胞瘤和12例双侧视网膜母细胞瘤病例。有12只眼属于里斯-埃尔斯沃思分级I-IV级，21只眼属于V级。在33只眼中，9只眼（27%）最初接受了眼球摘除术。其余24只眼（73%）最初接受了减瘤化疗（最多六个周期的卡铂、长春新碱、依托泊苷）或化疗热疗。在这24只眼中，20只眼通过局部治疗成功治愈（16只眼采用热疗加冷冻疗法，4只眼采用热疗加冷冻疗法加碘-125敷贴放疗），最终有2只眼接受了眼球摘除术，1例双侧V级视网膜母细胞瘤患儿被建议接受眼球摘除术但拒绝了。中位随访21个月，12只I-IV级眼和总共20/33只眼（60%）在未进行外照射的情况下保守治疗成功。在9例单侧视网膜母细胞瘤病例中，8例接受了眼球摘除术，但在24例双侧视网膜母细胞瘤眼中，19例（79%）通过保守治疗成功治愈。
对于里斯-埃尔斯沃思分级I-IV级的所有视网膜母细胞瘤眼，通过减瘤化疗联合局部治疗有可能根除存活的肿瘤。尽管V级视网膜母细胞瘤的21只眼中有8只眼（38%）在减瘤化疗和局部治疗后可能得以挽救，但对于那些出现视网膜全脱离和玻璃体广泛播散的眼，眼球摘除术仍是首选治疗方法。
