Ghassemi Fariba, Ghanaati Hossein, Karkhaneh Reza, Boujabadi Leila, Tabatabaie Seied Zia, Rajabi Mohammad Taher
Ocular Oncology and Retina and Vitreous Service, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Radiol. 2014 Aug;11(3):e16958. doi: 10.5812/iranjradiol.16958. Epub 2014 Aug 1.
The management of retinoblastoma remains a challenge to the multidisciplinary team, particularly as treatment affects not only visual outcomes, but also ocular retention and morbidity. Management of retinoblastoma has evolved over the past two decades.
To report the result of intra-ophthalmic artery chemotherapy (IAC) for the treatment of refractory and advanced retinoblastoma tumors.
All patients who had failed to respond adequately to previous treatments and six naive patients with advanced retinoblastoma, receiving IAC between 2009 and 2012, were included in this institutional interventional case series. The patients received 1-2 treatments of IAC given 4-8 weeks apart. Complete response was defined as regressed tumor and complete disappearance of seeding clinically and partial response was defined as partial regression of the tumor with live parts of the tumor and/or lessening of seeds, but not complete disappearance of them clinically.
A total of 24 eyes of 24 patients were treated with IAC during the study period. The mean age at the time of IAC was 38.9 months (14-120 months), and the mean follow-up was 16.8 months (3-36 months) after IAC. Tumor control was achieved in 14 eyes (58.3%). Type 3 (combined fleshy and calcified remnants) was the most common type of regression (37.5%). Complications included vitreous hemorrhage in nine eyes (37.5%), arterial occlusion in two (8.3%), cyclitic membrane possibly secondary to ischemia and tractional retinal detachment in one patient (4.2%), chorioretinal atrophy in three (12.5%) patients, and neovascular glaucoma in one eye (4.2%). In eight (33.3%) patients, no complication happened. Globe salvage was achieved in 62.5% of the cases. The success rate for naive patients was 84%. Sixty-seven percent of the cases received transpupillary thermotherapy and cryotherapy before IAC.
Intra-ophthalmic artery melphalan is an effective treatment for advanced cases of retinoblastoma, with a reasonable level of success. In the short follow up period of this study, it appears that the primary cases showed better results in the control of tumor.
视网膜母细胞瘤的管理对多学科团队来说仍然是一项挑战，尤其是因为治疗不仅会影响视觉效果，还会影响眼球保留率和发病率。在过去二十年中，视网膜母细胞瘤的管理方法不断发展。
报告眼内动脉化疗（IAC）治疗难治性和晚期视网膜母细胞瘤肿瘤的结果。
本机构介入性病例系列纳入了所有对先前治疗反应不佳的患者以及6例初治的晚期视网膜母细胞瘤患者，这些患者在2009年至2012年期间接受了IAC治疗。患者接受1-2次IAC治疗，间隔4-8周。完全缓解定义为肿瘤消退且临床上播种完全消失，部分缓解定义为肿瘤部分消退，肿瘤仍有存活部分和/或播种减少，但临床上未完全消失。
在研究期间，共有24例患者的24只眼接受了IAC治疗。IAC治疗时的平均年龄为38.9个月（14-120个月），IAC治疗后的平均随访时间为16.8个月（3-36个月）。14只眼（58.3%）实现了肿瘤控制。3型（混合性肉质和钙化残留）是最常见的消退类型（37.5%）。并发症包括9只眼（37.5%）发生玻璃体积血，2只眼（8.3%）发生动脉阻塞，1例患者（4.2%）可能继发于缺血和牵引性视网膜脱离的睫状膜，3例（12.5%）患者发生脉络膜视网膜萎缩，1只眼（4.2%）发生新生血管性青光眼。8例（33.3%）患者未发生并发症。62.5%的病例实现了眼球挽救。初治患者的成功率为84%。67%的病例在IAC治疗前接受了经瞳孔温热疗法和冷冻疗法。
美法仑眼内动脉化疗是治疗晚期视网膜母细胞瘤的有效方法，成功率合理。在本研究的短期随访期内，似乎初治病例在肿瘤控制方面显示出更好的结果。
