Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
Pediatr Blood Cancer. 2012 Nov;59(5):859-64. doi: 10.1002/pbc.24170. Epub 2012 Apr 10.
Superselective delivery of chemotherapy through the ophthalmic artery, i.e. ophthalmic artery chemosurgery, has been used for the treatment of advanced intraocular retinoblastoma. Herein, we evaluate the efficacy of ophthalmic artery chemosurgery for retinoblastoma associated with >50% retinal detachment.
Retrospective review of 37 eyes of 34 retinoblastoma patients who had extensive (>50%) bullous non-rhegmatogenous retinal detachments and received ophthalmic artery chemosurgery either as primary treatment or as "salvage" treatment after failed multi-cycle intravenous chemotherapy and/or external beam radiation (mean follow-up, 21 months). Data on patient and ocular survival, complications of ophthalmic artery chemosurgery treatments, time course of retinal reattachment, and serial electroretinograms (ERG) were collected.
A total of 134 ophthalmic artery chemosurgery injections were performed. All children survive. Five eyes (5/37; 14%) were enucleated for progression of disease. The Kaplan-Meier enucleation-free survival rate at 2 years was 87.9% (95% confidence interval, 76.5-99.3%). The retina reattached in 28 eyes (28/37; 76%) and the 30-Hz flicker ERGs improved by >25 µV in seven eyes (7/37; 19%), remained stable (change < 25 µV) in 26 eyes (26/37; 70%), and decreased by >25 µV in four eyes (4/37; 11%). The Kaplan-Meier retinal reattachment rate was 58% after 3 months and three ophthalmic artery chemosurgery infusions (95% confidence interval, 41.9-74.1%).
Ophthalmic artery chemosurgery is effective in preventing enucleation, promoting retinal reattachment and preserving or improving retinal function in the majority of eyes with advanced retinoblastoma and >50% retinal detachment that would otherwise be considered for enucleation.
通过眼动脉进行超选择性化疗，即眼动脉化疗，已用于治疗晚期眼内视网膜母细胞瘤。在此，我们评估眼动脉化疗治疗广泛 (>50%) 疱状非孔源性视网膜脱离的视网膜母细胞瘤的疗效。
回顾性分析 34 例视网膜母细胞瘤患者 37 只眼的资料，这些患者均患有广泛 (>50%) 疱状非孔源性视网膜脱离，并接受眼动脉化疗治疗，治疗方式为初始治疗或在多周期静脉化疗和/或外照射失败后的“挽救”治疗(平均随访 21 个月)。收集患者和眼存活率、眼动脉化疗治疗并发症、视网膜再附着时间和连续视网膜电图(ERG)的数据。
共行 134 次眼动脉化疗注射。所有患儿均存活。5 只眼(5/37;14%)因疾病进展而行眼球摘除术。2 年Kaplan-Meier 无眼球摘除生存率为 87.9%(95%置信区间，76.5%-99.3%)。28 只眼(28/37;76%)视网膜复位，37 只眼中 7 只眼(7/37;19%)的 30-Hz 闪烁 ERG 改善>25µV，26 只眼(26/37;70%)保持稳定(变化<25µV)，4 只眼(4/37;11%)下降>25µV。3 个月和 3 次眼动脉化疗后，Kaplan-Meier 视网膜复位率为 58%(95%置信区间，41.9%-74.1%)。
眼动脉化疗在预防眼球摘除、促进视网膜再附着以及保留或改善大多数广泛 (>50%) 视网膜脱离且原本考虑行眼球摘除的晚期视网膜母细胞瘤眼的视网膜功能方面是有效的。
