Francis Jasmine H, Abramson David H, Gobin Y Pierre, Marr Brian P, Tendler Irwin, Brodie Scott E, Dunkel Ira J
Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Ophthalmology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Ophthalmology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
Ophthalmology. 2015 May;122(5):1016-22. doi: 10.1016/j.ophtha.2014.11.029. Epub 2015 Jan 21.
Assess the usefulness of second-course ophthalmic artery chemosurgery (OAC) for patients with intraocular retinoblastoma that recurred after prior OAC. This study evaluated the efficacy and toxicity of second-course OAC.
Single-arm retrospective study of 29 eyes of 30 patients treated with second-course OAC at Memorial Sloan Kettering Cancer Center between May 2006 and July 2013, with a median follow-up of 25.9 months.
Retinoblastoma patients who underwent a course of OAC, with a minimum of 2 months of progression-free follow-up at monthly examinations, but who subsequently received additional OAC for recurrent tumor.
To determine efficacy, Kaplan-Meier survival estimates were generated and the Mantel-Cox test was used to compare curves. To determine toxicity, electroretinography (ERG) amplitudes were measured in response to 30-Hz photopic flicker stimulation before and after OAC treatment; systemic adverse events were graded according to the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE 4.0).
For efficacy, ocular progression-free survival, ocular event-free survival (e.g., enucleation, external-beam radiation, or intravitreal melphalan), and ocular survival. For toxicity, peak-to-peak comparisons between ERG studies before and after OAC treatment and CTCAE 4.0-graded systemic adverse events.
Fifty percent of all recurrences were within 4.4 months and 90% were within 16 months of completion of the first course of OAC. The 2-year Kaplan-Meier ocular survival, event-free survival, and progression-free survival estimates after second-course OAC were 82.8% (95% confidence interval [CI], 60.1%-93.2%), 57.3% (95% CI, 36.1%-73.7%), and 26.5% (95% CI, 11.0%-45.0%), respectively. All eyes without vitreous seeding were progression free, whereas eyes with vitreous seeding were associated significantly with worse ocular survival after second-course OAC (P = 0.03). After second-course OAC, 90% of eyes had stable or improved ERG responses. Of all evaluable cases, there was no increased risk of systemic toxicity during the second course compared with the initial course of OAC.
Retinoblastoma eyes requiring second-course OAC after initial OAC treatment have good salvage rates, and the treatment has an acceptable ocular and systemic toxicity profile. However, these eyes often require additional (third- or fourth-course) OAC or other treatment methods because of progression of disease after second-line OAC, particularly if vitreous seeds are present at the time of initial OAC failure.
评估二次眼科动脉化疗（OAC）对先前接受过OAC治疗后复发的眼内视网膜母细胞瘤患者的有效性。本研究评估了二次OAC的疗效和毒性。
对2006年5月至2013年7月在纪念斯隆凯特琳癌症中心接受二次OAC治疗的30例患者的29只眼进行单臂回顾性研究，中位随访时间为25.9个月。
接受过一个疗程OAC治疗的视网膜母细胞瘤患者，每月检查至少有2个月无疾病进展的随访期，但随后因肿瘤复发接受了额外的OAC治疗。
为确定疗效，生成Kaplan-Meier生存估计值，并使用Mantel-Cox检验比较曲线。为确定毒性，在OAC治疗前后，通过30赫兹明视闪烁刺激测量视网膜电图（ERG）振幅；全身不良事件根据不良事件通用术语标准第4.0版（CTCAE 4.0）进行分级。
对于疗效，观察无眼部进展生存期、无眼部事件生存期（如眼球摘除、外照射放疗或玻璃体内美法仑注射）和眼部生存期。对于毒性，比较OAC治疗前后ERG研究的峰峰值，并对CTCAE 4.0分级的全身不良事件进行评估。
所有复发中有50%发生在第一个疗程OAC完成后的4.4个月内，90%发生在16个月内。二次OAC治疗后2年的Kaplan-Meier眼部生存期、无事件生存期和无进展生存期估计值分别为82.8%（95%置信区间[CI]，60.1%-93.2%）、57.3%（95%CI，36.1%-73.7%）和26.5%（95%CI，11.0%-45.0%）。所有无玻璃体种植的眼均无疾病进展，而有玻璃体种植的眼在二次OAC治疗后的眼部生存期明显较差（P = 0.03）。二次OAC治疗后，90%的眼ERG反应稳定或改善。在所有可评估的病例中，与初始OAC疗程相比，二次疗程期间全身毒性风险没有增加。
初始OAC治疗后需要二次OAC的视网膜母细胞瘤眼具有良好的挽救率，且该治疗具有可接受的眼部和全身毒性特征。然而，由于二线OAC治疗后疾病进展，尤其是在初始OAC治疗失败时存在玻璃体种植的情况下，这些眼通常需要额外的（第三次或第四次）OAC或其他治疗方法。
