Qian Jiang, Xue Kang, Gao Yi-jin, Yuan Yi-fei, Shan Hai-dong, Bi Ying-wen
Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China.
Zhonghua Yan Ke Za Zhi. 2010 Apr;46(4):312-6.
To evaluate the therapeutic efficiency of customized combined therapy for retinoblastoma.
Retrospective case series. Twenty nine patients (40 eyes) with retinoblastoma were accepted customized combined therapy between Jan. 2005 and Dec. 2007 in our hospital. The combined therapy included chemoreduction using vincristine, etoposide, and carboplatin (VEC) combined with local cryotherapy and/or transpupillary thermotherapy (TTT). The average follow-up duration was 38 months and ranging from 12 to 50 months.
Twenty five patients had bilateral retinoblastoma, 4 patients had unilateral retinoblastoma. The stages of 40 eyes were classified according to the International Intraocular Retinoblastoma Classification, 14 eyes (35%) were group A, 9 eyes (22.5%) were group B, 4 eyes (10%) were group C, 10 eyes (25%) were group D, and 3 eyes (7.5%) were group E. Seventeen eyes had vitreous and/or subretinal seeds. The overall globe preservation rate was 75% (30/40); and was 100% (14/14) in group A, 100% (9/9) in group B, 75% (3/4) in group C, 40% (4/10) in group D and 0% (0/3) in group E. A progressive decrease of globe preservation rate was observed in eyes with advanced stages. Tumor recurrence was detected in 4 eyes after chemoreduction, leading to the enucleation. Ten eyes were enucleated in the present series, with 1 eye in group C, 6 eyes in group D and 3 eyes in group E. None of 29 patients died during the follow-up. No patients had any serious side effect of chemotherapy such as leukemia.
The customized combined therapy can effectively preserve certain patients' eyeballs and even obtain useful visual function. The International Intraocular Retinoblastoma Classification is useful in the clinical management of retinoblastoma.
评估视网膜母细胞瘤定制化联合治疗的疗效。
回顾性病例系列研究。2005年1月至2007年12月期间，我院对29例（40只眼）视网膜母细胞瘤患者采用了定制化联合治疗。联合治疗包括使用长春新碱、依托泊苷和卡铂（VEC）进行化疗减积，并联合局部冷冻疗法和/或经瞳孔温热疗法（TTT）。平均随访时间为38个月，范围为12至50个月。
25例患者为双侧视网膜母细胞瘤，4例患者为单侧视网膜母细胞瘤。根据国际眼内视网膜母细胞瘤分类法对40只眼进行分期，14只眼（35%）为A组，9只眼（22.5%）为B组，4只眼（10%）为C组，10只眼（25%）为D组，3只眼（7.5%）为E组。17只眼有玻璃体和/或视网膜下种植灶。眼球总体保留率为75%（30/40）；A组为100%（14/14），B组为100%（9/9），C组为75%（3/4），D组为40%（4/10），E组为0%（0/3）。晚期眼的眼球保留率呈逐渐下降趋势。化疗减积后4只眼检测到肿瘤复发，导致眼球摘除。本系列中有10只眼被摘除，其中C组1只眼，D组6只眼，E组3只眼为。29例患者在随访期间均无死亡。无患者出现化疗的任何严重副作用，如白血病。
定制化联合治疗可有效保留部分患者的眼球，甚至获得有用的视觉功能。国际眼内视网膜母细胞瘤分类法在视网膜母细胞瘤的临床管理中有用。
