Sussman Daniel A, Escalona-Benz Erika, Benz Matthew S, Hayden Brandy C, Feuer William, Cicciarelli Nicole, Toledano Stuart, Markoe Arnold, Murray Timothy G
Bascom Palmer Eye Institute, University of Miami School of Medicine, FL 33101, USA.
Arch Ophthalmol. 2003 Jul;121(7):979-84. doi: 10.1001/archopht.121.7.979.
To determine the time course and extent of tumor reduction associated with systemic chemotherapy or external beam radiotherapy (EBRT) in the treatment of advanced intraocular retinoblastoma.
Retrospective review of children with Reese-Ellsworth stages IV and V retinoblastoma undergoing primary globe-conserving therapy with either systemic chemoreduction or EBRT. Study variables were recorded at baseline, at monthly intervals for the first 6 months, and at 12 months after the initiation of treatment. Tumor volumes were calculated using basal area and height values determined by ultrasonography, physical examination, and fundus photographic review.
Outcome measures included tumor volume, tumor reduction, regression pattern, treatment-related complications, metastases, and survival.
Twenty-six eyes of 26 patients were evaluated for tumor response; 18 patients were treated with systemic chemotherapy and 8 patients were treated with EBRT. Median follow-up was 36 months. A mean 68% reduction in tumor volume occurred after 1 cycle of chemotherapy compared with a 12% reduction at a similar time point (1 month) after initiation of EBRT (P<.004). There was no statistically significant difference in tumor volume reduction between treatment modalities at the 12-month follow-up visit. Both systemic chemoreduction and EBRT achieved 100% globe conservation and 100% patient survival in this series.
Retinoblastoma reduction exhibits a differential time course based on the applied primary treatment. Systemic chemotherapy is associated with earlier tumor reduction than EBRT.
确定全身化疗或外照射放疗（EBRT）治疗晚期眼内视网膜母细胞瘤时肿瘤缩小的时间进程和程度。
回顾性分析接受全身化疗减瘤或EBRT进行初次保眼球治疗的Reese-Ellsworth分期IV和V期视网膜母细胞瘤患儿。研究变量在基线时、治疗开始后的前6个月每月记录一次，并在治疗开始后12个月记录。使用超声检查、体格检查和眼底照相检查确定的基底面积和高度值计算肿瘤体积。
观察指标包括肿瘤体积、肿瘤缩小情况、消退模式、治疗相关并发症、转移和生存率。
对26例患者的26只眼进行了肿瘤反应评估；18例患者接受全身化疗，8例患者接受EBRT。中位随访时间为36个月。化疗1个周期后肿瘤体积平均缩小68%，而在EBRT开始后类似时间点（1个月）肿瘤体积缩小12%（P<0.004）。在12个月随访时，不同治疗方式之间肿瘤体积缩小无统计学显著差异。在本系列研究中，全身化疗减瘤和EBRT均实现了100%的眼球保留率和100%的患者生存率。
视网膜母细胞瘤缩小情况根据所应用的初始治疗呈现出不同的时间进程。全身化疗比EBRT能使肿瘤更早缩小。
