Balwierz W, Kobylarz J, Starzycka M, Dluzniewska A
Klinika Hematologii i Onkologii Dzieciecej, Polsko-Amerykanski Instytut Pediatrii Collegium Medicum, Uniwersytet Jagielonski, Wielicka 265, 30-663 Krakow, Poland.
Med Wieku Rozwoj. 2001 Jul-Sep;5(3 Suppl 1):15-23.
Until recently chemotherapy in retinoblastoma was used as adjuvant therapy after enucleation in cases with extraretinal spread of the disease (weal extension, orbital extension, neoplastic infiltrates of the optic nerve at resection line, intracranial metastasis and generalized disease). Recent experience has proved that use of chemotherapy for intraocular retinoblastoma before local treatment (so called "chemoreduction") has allowed not only to decrease the number of enucleations and indications for external beam irradiation or limit the extension of local therapy; but also to increase the chances for vision preservation and to decrease the risk of severe complications. Twenty children aged 0,5-96 months (with lesions in 29 eyes) in whom intraocular retinoblastoma was diagnosed between January 1996 and June 2000, were the subject of this study. Among 29 children, in 15 (52%) stage V according to Reese-Ellsworth was established. Enucleation before chemotherapy was necessary in 9 cases, and in two more children the eye had to be removed after 1-2 courses of chemotherapy. In 11 remaining children (with 18 involved eyes) VEC chemotherapy combined with delayed local therapy (cryotherapy, photocoagulation, brachytherapy) was employed. Out of 18 treated cases enucleation could be avoided in 13 (72%), including 12 qualified as Reese-Ellsworth stage II or I. No eye with stage V could be saved. First-line chemotherapy combined with local treatment should be standard treatment for intraocular retinoblastoma groups I and II. More effective therapy is required for advanced cases particularly for Reese-Ellsworth eye group V.
直到最近，视网膜母细胞瘤的化疗还仅用于疾病出现视网膜外扩散（脉络膜扩散、眼眶扩散、切除线处视神经肿瘤浸润、颅内转移及全身疾病）的病例在眼球摘除术后作为辅助治疗。最近的经验证明，在局部治疗前对眼内视网膜母细胞瘤使用化疗（即所谓的“化学减容”），不仅可以减少眼球摘除的数量以及外照射的指征或限制局部治疗的范围；还能增加保留视力的机会并降低严重并发症的风险。本研究的对象是1996年1月至2000年6月间诊断为眼内视网膜母细胞瘤的20名年龄在0.5 - 96个月的儿童（29只眼有病变）。在这29名儿童中，根据里斯-埃尔斯沃思分类法，有15名（52%）为V期。9例在化疗前需要进行眼球摘除，另外2名儿童在进行1 - 2个疗程的化疗后也不得不摘除眼球。其余11名儿童（18只受累眼）采用了VEC化疗联合延迟局部治疗（冷冻疗法、光凝疗法、近距离放射疗法）。在18例接受治疗的病例中，13例（72%）避免了眼球摘除，其中包括12例符合里斯-埃尔斯沃思I期或II期标准的病例。没有一只V期的眼睛得以挽救。一线化疗联合局部治疗应成为I组和II组眼内视网膜母细胞瘤的标准治疗方法。对于晚期病例，尤其是里斯-埃尔斯沃思V组的病例，需要更有效的治疗方法。
