Shields Carol L, Mashayekhi Arman, Cater Jacqueline, Shelil Abdallah, Ness Steven, Meadows Anna T, Shields Jerry A
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA.
Arch Ophthalmol. 2005 Jun;123(6):765-73. doi: 10.1001/archopht.123.6.765.
To evaluate the effectiveness of chemoreduction alone and chemoreduction with thermotherapy for macular retinoblastoma.
Prospective, nonrandomized, single-center case series.
Ocular Oncology Service at Wills Eye Hospital of Thomas Jefferson University in conjunction with the Division of Oncology at the Children's Hospital of Philadelphia (Pa).
There were 68 macular retinoblastomas in 62 eyes of 49 patients managed with chemoreduction from January 1995 through January 2003. Intervention All patients received 6 cycles of intravenous chemoreduction using vincristine, etoposide, and carboplatin. The patients were then treated according to 1 of 2 approaches: chemoreduction alone with no adjuvant focal therapy (group A) or chemoreduction combined with adjuvant foveal-sparing thermotherapy to each macular retinoblastoma (group B). Main Outcome Measure Tumor recurrence.
Of the 68 tumors, 28 were in group A and 40 were in group B. A comparison of both groups revealed that the tumors were similar with regard to clinical features. The mean tumor basal dimension was 12.3 mm for group A and 12.1 mm for group B, and the mean tumor thickness was 6.8 mm for group A and 6.1 mm for group B. Tumors in group A occupied a mean of 71% of the macula, and those in group B occupied 74% of the macula. Following treatment, Kaplan-Meier estimates revealed that group A tumors showed recurrence in 25% by 1 year and 35% by 4 years whereas those in group B showed recurrence in 17% by 1 year and 17% by 4 years. All recurrences were treated with additional focal thermotherapy, cryotherapy, or plaque radiotherapy except for 1 that required external beam radiotherapy and 1 that required enucleation, both in group A. Univariate analysis revealed that predictors of tumor recurrence were intraretinal growth pattern (vs endophytic); small tumor basal dimension (less than 3 mm and occupying a smaller percentage of the macula); absence of subretinal fluid, subretinal seeds, and vitreous seeds; and chemoreduction response with less tumor calcification and tumor regression of type 0 (complete disappearance without a scar). By multivariate analysis, the most important factors predictive of tumor recurrence were smaller macular tumor size (judged by percentage of the macula occupied by the tumor), absence of subretinal or vitreous seeds, and unilateral disease.
Treatment of macular retinoblastoma with chemoreduction plus adjuvant foveal-sparing thermotherapy provides tumor control of 83% by 4 years, and this is slightly more favorable than chemoreduction alone, which provides control of 65% by 4 years. Tumors most destined for recurrence are small tumors.
评估单纯化疗及化疗联合热疗治疗黄斑区视网膜母细胞瘤的有效性。
前瞻性、非随机、单中心病例系列研究。
托马斯·杰斐逊大学威尔斯眼科医院眼科肿瘤服务部与宾夕法尼亚州费城儿童医院肿瘤科联合开展。
1995年1月至2003年1月期间，49例患者的62只眼中有68个黄斑区视网膜母细胞瘤接受了化疗。干预措施所有患者均接受6个周期的静脉化疗，使用长春新碱、依托泊苷和卡铂。然后根据以下两种方法之一对患者进行治疗：单纯化疗且不进行辅助局部治疗（A组）或化疗联合对每个黄斑区视网膜母细胞瘤进行辅助性保留黄斑中心凹热疗（B组）。主要观察指标肿瘤复发情况。
68个肿瘤中，28个在A组，40个在B组。两组比较显示，肿瘤在临床特征方面相似。A组肿瘤基底平均直径为12.3mm，B组为12.1mm；A组肿瘤平均厚度为6.8mm，B组为6.1mm。A组肿瘤平均占据黄斑区的71%，B组为74%。治疗后，Kaplan-Meier估计显示，A组肿瘤1年时复发率为25%，4年时为35%；而B组肿瘤1年时复发率为17%，4年时为17%。除A组有1例需要外照射放疗和1例需要眼球摘除外，所有复发病例均接受了额外的局部热疗、冷冻疗法或敷贴放射治疗。单因素分析显示，肿瘤复发的预测因素包括视网膜内生长模式（与内生性相比）；肿瘤基底直径小（小于3mm且占据黄斑区的比例较小）；无视网膜下液、视网膜下播散灶和玻璃体播散灶；化疗反应为肿瘤钙化较少且肿瘤消退为0型（完全消失无瘢痕）。多因素分析显示，预测肿瘤复发的最重要因素是黄斑区肿瘤较小（根据肿瘤占据黄斑区的比例判断）、无视网膜下或玻璃体播散灶以及单侧患病。
化疗联合辅助性保留黄斑中心凹热疗治疗黄斑区视网膜母细胞瘤4年时的肿瘤控制率为83%，略优于单纯化疗，单纯化疗4年时的肿瘤控制率为65%。最易复发的肿瘤是小肿瘤。
