Unit NINT Neuroimaging and Neurointervention, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy.
Acta Ophthalmol. 2013 Jun;91(4):335-42. doi: 10.1111/j.1755-3768.2011.02296.x. Epub 2012 Jan 23.
To report our experience in superselective ophthalmic artery infusion of melphalan (SOAIM) for intraocular retinoblastoma.
From June 2008 to October 2010, 38 patients (18 women, 20 men; age range at first treatment, 7 months to 22 years) with 41 eyes with retinoblastoma were scheduled for SOAIM, for 17 newly diagnosed retinoblastomas Tumour, Node and Metastasis (TNM) 7th Edition 1a (n = 1), 1b (n = 1), 2a (n = 7), 2b (n = 4) and 3a (n = 4) and 24 retinoblastomas with partial remission/relapse TNM 7th Edition 1b (n = 13), 2a (n = 1) and 2b (n = 10). Eight patients (ten eyes) have been treated by SOAIM alone. Follow-up was 6-27 months in 28 patients (30 eyes).
Ophthalmic artery cannulation failed in two patients. Thirty-six patients underwent 140 treatments by internal (n = 112) or external (n = 28) carotid arteries. No major procedural complications occurred. Two patients have been lost to follow-up. Remaining 34 patients (37 eyes) had no metastatic disease. Four patients suffered permanent ocular complications: chorioretinal dystrophy (n = 2), ptosis (n = 1) and strabismus/exotropia (n = 1). Eight (22%) eyes in eight (24%) patients underwent enucleation: 7/16 (43%) newly diagnosed retinoblastomas and 1/22 (4.5%) retinoblastomas undergoing partial remission/relapse. For all treated eyes, Kaplan-Meier eye enucleation-free rates (K-M) were 85.4% (95% CI, 73.3-97.5%), 74.4% (95% CI, 57-91.8%) and still stable at 6, 12 months and 2 years, respectively. For eyes with partial remission/relapse, and eyes at presentation, K-M at 2 years were 95.5% (95% CI, 86.9-100%) and 45.6% (95% CI, 16.6-74.6%), respectively.
Superselective ophthalmic artery infusion of melphalan was safe and powerful, especially following other therapies. Superselective ophthalmic artery infusion of melphalan should be added to focal therapies spectrum. In selected cases, melphalan should be combined with other chemotherapeutic agents.
报告我们在眼动脉内输注氨甲蝶呤（SOAIM）治疗眼内视网膜母细胞瘤的经验。
从 2008 年 6 月至 2010 年 10 月，38 例（18 名女性，20 名男性；首次治疗时年龄范围为 7 个月至 22 岁）的 41 只眼患有视网膜母细胞瘤，安排进行 SOAIM，其中 17 只为新诊断的视网膜母细胞瘤（肿瘤、淋巴结和转移（TNM）第 7 版 1a（n = 1）、1b（n = 1）、2a（n = 7）、2b（n = 4）和 3a（n = 4）），24 只眼为部分缓解/复发的视网膜母细胞瘤（TNM 第 7 版 1b（n = 13）、2a（n = 1）和 2b（n = 10））。8 例（10 只眼）患者仅接受 SOAIM 治疗。28 例（30 只眼）患者随访 6-27 个月。
两名患者的眼动脉插管失败。36 名患者通过颈内动脉（n = 112）或颈外动脉（n = 28）进行了 140 次治疗。没有发生重大程序并发症。两名患者失访。其余 34 名（37 只眼）患者无转移疾病。4 名患者出现永久性眼部并发症：脉络膜视网膜营养不良（n = 2）、上睑下垂（n = 1）和斜视/外斜视（n = 1）。8 只眼（8 只眼）的 8 名患者（24%）接受了眼球摘除术：7/16 只眼（43%）为新诊断的视网膜母细胞瘤，1/22 只眼（4.5%）为部分缓解/复发的视网膜母细胞瘤。对于所有治疗的眼睛，Kaplan-Meier 眼摘除无病生存率（K-M）分别为 85.4%（95%CI，73.3-97.5%）、74.4%（95%CI，57-91.8%），在 6、12 个月和 2 年时仍保持稳定。对于部分缓解/复发的眼睛和初诊时的眼睛，2 年时的 K-M 分别为 95.5%（95%CI，86.9-100%）和 45.6%（95%CI，16.6-74.6%）。
眼动脉内输注氨甲蝶呤是安全有效的，尤其是在其他治疗之后。眼动脉内输注氨甲蝶呤应加入局部治疗范围。在选择的病例中，氨甲蝶呤应与其他化疗药物联合使用。
