Frikha H, Chaari N, Nasr C, Bouguila H, Chebbi A, Bhouri L, Hentati D, Kochbati L, Besbes M, Rifi H, Oubiche F, Ayed S, Maalej M
Unité de recherche, radiothérapie oculaire et cervico-faciale, service de radiothérapie, institut Salah-Azaiz-Bab-Saadoun, boulevard du 9-Avril, 1006 Tunis, Tunisie.
Cancer Radiother. 2009 Jan;13(1):30-6. doi: 10.1016/j.canrad.2008.08.001. Epub 2008 Sep 13.
The aim of this study is to analyze the results and the complications of radiotherapy in the treatment of retinoblastoma.
Between 1994 and 2004, 40 children received radiotherapy for a retinoblastoma in Salah Azaiz Institute. The average age of the patients was 36 months (four to 132 months). There were 16 girls and 24 boys. Sixteen children presented a bilateral disease and 24 children a unilateral disease. Twenty eyes and thirty-six orbital cavities in 40 children with retinoblastoma were treated by radiotherapy. One child with a unilateral anterior retinoblastoma was treated with 106 ruthenium brachytherapy. External radiotherapy has been used to treat the 39 patients. In 20 cases the irradiation was conservative and in 36 cases postoperatively. The latter (n=36) presented at least one risk factor of relapses noted in the histological examination. The average dose was 44 Gy (1.8 to 2 Gy per fraction, five fractions weekly). This radiotherapy was associated with chemotherapy in 24 cases.
Thirty-five children were followed with an average follow-up of 53 months (3-108 months). The average delay of relapses was of 10 months (two to 26 months). We found four orbital relapses and seven metastasis in nine children. The conservation of the eye with a useful visual field was noted in 18 cases among the 20 conservative irradiated eyes. The major therapeutic complication was the growth defect of the bones face. A femoral bone sarcoma was noted five years after the end of the irradiation and chemotherapy in one case.
If the radiotherapy offers the advantage of the functional conservation and the improvement of the local control, its indications are more and more restricted in favor of the other therapeutic methods (chemotherapy, thermochemotherapy) and this considering the iatrogene risk. The development of new techniques of brachytherapy and the progresses of the conformational radiotherapy appear to reduce considerably this risk.
本研究旨在分析视网膜母细胞瘤放射治疗的结果及并发症。
1994年至2004年间，40名儿童在萨拉赫·阿扎伊兹研究所接受了视网膜母细胞瘤放射治疗。患者的平均年龄为36个月（4至132个月）。其中有16名女孩和24名男孩。16名儿童为双侧患病，24名儿童为单侧患病。40例视网膜母细胞瘤患儿的20只眼和36个眼眶接受了放射治疗。1例单侧前部视网膜母细胞瘤患儿接受了106钌近距离放射治疗。39例患者采用了外照射放疗。20例为保守照射，36例为术后照射。后者（n = 36）在组织学检查中呈现至少一项复发风险因素。平均剂量为44 Gy（每次分割1.8至2 Gy，每周5次分割）。24例患者的放射治疗联合了化疗。
35名儿童接受了随访，平均随访时间为53个月（3至108个月）。复发的平均延迟时间为10个月（2至26个月）。我们在9名儿童中发现了4例眼眶复发和7例转移。20只接受保守照射的眼中，有18例保留了具有有用视野的眼睛。主要的治疗并发症是面部骨骼生长缺陷。1例患者在放疗和化疗结束5年后出现了股骨骨肉瘤。
尽管放射治疗具有功能保留和局部控制改善的优势，但其适应证越来越受到限制，转而支持其他治疗方法（化疗、热化疗），这是考虑到医源性风险。近距离放射治疗新技术的发展和适形放疗的进步似乎可大幅降低此风险。
