Shields Carol L, Mashayekhi Arman, Cater Jacqueline, Shelil Abdallah, Meadows Anna T, Shields Jerry A
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Trans Am Ophthalmol Soc. 2004;102:35-44; discussion 44-5.
To evaluate individual tumor control following chemoreduction for retinoblastoma.
Prospective nonrandomized single-center case series of 457 retinoblastomas managed with six cycles of chemoreduction (vincristine, etoposide, and carboplatin). The tumors were then managed with chemoreduction alone (group A) or chemoreduction combined with thermotherapy (group B), cryotherapy (group C), or both thermotherapy and cryotherapy (group D). The main outcome measure was development of tumor recurrence.
Of 457 retinoblastomas, 63 (14%) were in group A, 256 (56%) in group B, 127 (28%) in group C, and 11 (2%) in group D. The tumor was located in the macula in 33 (52%) of group A, 109 (43%) of group B, 3 (2%) of group C, and 1 (9%) of group D. Using Kaplan-Meier analysis, recurrence of the individual retinoblastoma at 7 years was found in 45% of group A and in 18% of combined groups B, C, and D. Treatment of the 93 tumor recurrences included thermotherapy, cryotherapy, or plaque radiotherapy in 62 cases (67%) and external beam radiotherapy or enucleation in 31 cases (33%). Risk factors predictive of tumor recurrence by multivariate analysis included macular tumor location for all groups and, additionally, female sex for group A and increasing tumor thickness for groups B, C, and D.
Chemoreduction alone or combined with cryotherapy and/or thermotherapy is effective for treatment of retinoblastoma, but tumor recurrence is greatest for those located in the macula and those with greater thickness. Globe salvage is usually achieved despite tumor recurrence.
评估视网膜母细胞瘤化疗减瘤后的个体肿瘤控制情况。
对457例视网膜母细胞瘤进行前瞻性非随机单中心病例系列研究，采用六个周期的化疗减瘤方案（长春新碱、依托泊苷和顺铂）。然后，这些肿瘤分别采用单纯化疗减瘤（A组）或化疗减瘤联合热疗（B组）、冷冻疗法（C组）或热疗与冷冻疗法联合（D组）进行治疗。主要观察指标是肿瘤复发情况。
457例视网膜母细胞瘤中，A组63例（14%），B组256例（56%），C组127例（28%），D组11例（2%）。肿瘤位于黄斑区的情况为：A组33例（52%），B组109例（43%），C组3例（2%），D组1例（9%）。采用Kaplan-Meier分析，A组7岁时个体视网膜母细胞瘤的复发率为45%，B、C、D联合组为18%。93例肿瘤复发的治疗包括：62例（67%）采用热疗、冷冻疗法或敷贴放疗，31例（33%）采用外照射放疗或眼球摘除术。多因素分析预测肿瘤复发的危险因素包括：所有组的黄斑区肿瘤位置，此外，A组为女性，B、C、D组为肿瘤厚度增加。
单纯化疗减瘤或联合冷冻疗法和/或热疗对视网膜母细胞瘤有效，但位于黄斑区和厚度较大的肿瘤复发率最高。尽管肿瘤复发，通常仍可实现眼球挽救。
