单侧视网膜母细胞瘤经静脉化疗与经动脉化疗治疗的比较。基于视网膜母细胞瘤国际分类的结果。
Unilateral Retinoblastoma Managed With Intravenous Chemotherapy Versus Intra-Arterial Chemotherapy. Outcomes Based on the International Classification of Retinoblastoma.
机构信息
From the *Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA; †Ribeirão Preto Medical School, University of São Paulo, Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, São Paulo, Brazil; ‡Nemours Center for Cancer and Blood Disorders, Nemours/Alfred I. DuPont Hospital for Children at Thomas Jefferson University; §Pediatric Oncology Department, The Children's Hospital of Philadelphia, University of Pennsylvania; and ¶Department of Neurovascular and Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA.
出版信息
Asia Pac J Ophthalmol (Phila). 2016 Mar-Apr;5(2):97-103. doi: 10.1097/APO.0000000000000172.
PURPOSE
The objective of this study was to compare outcomes after intravenous chemotherapy (IVC) versus intra-arterial chemotherapy (IAC) for unilateral retinoblastoma.
DESIGN
A retrospective comparative interventional case series.
METHODS
Patients with unilateral retinoblastoma managed with either IVC using vincristine, etoposide, and carboplatin or IAC using melphalan with or without topotecan with a minimum of 1-year follow-up were compared. The primary outcome measure was globe salvage.
RESULTS
Of 91 patients with unilateral retinoblastoma, IVC was employed in 42 (46%) cases and IAC in 49 (54%). By comparison (IVC vs IAC), patients in the IAC group had greater mean tumor diameter (14 vs 18 mm, P < 0.001) and thickness (7 vs 10 mm, P = 0.001), greater percentage with active vitreous seeds (29% vs 55%, P = 0.01), and greater total retinal detachment (10% vs 43%, P < 0.001). There were no cases of group A in either treatment arm. Globe salvage was not significantly different in groups B, C, or E, but there was significantly improved globe salvage with IAC for group D (48% vs 91%, P = 0.004). Control was significantly better with IAC for solid tumor (62% vs 92%, P = 0.002), subretinal seeds (31% vs 86%, P = 0.006), and vitreous seeds (25% vs 74%, P = 0.006). There were no patients with pinealoblastoma, second cancer, metastasis, or death in either group.
CONCLUSIONS
For unilateral retinoblastoma, IAC provided significantly superior globe salvage compared with IVC for group D eyes. In addition, IAC provided significantly superior control for solid tumor, subretinal seeds, and vitreous seeds.
目的
本研究旨在比较单侧视网膜母细胞瘤静脉化疗（IVC）与动脉内化疗（IAC）的疗效。
设计
回顾性比较干预性病例系列研究。
方法
比较了接受长春新碱、依托泊苷和卡铂静脉化疗或甲氨蝶呤联合或不联合拓扑替康动脉内化疗治疗、随访时间至少 1 年的单侧视网膜母细胞瘤患者。主要结局指标为眼球保存率。
结果
91 例单侧视网膜母细胞瘤患者中，42 例（46%）采用 IVC 治疗，49 例（54%）采用 IAC 治疗。与 IVC 组相比，IAC 组患者的肿瘤平均直径（14 毫米对 18 毫米，P < 0.001）和厚度（7 毫米对 10 毫米，P = 0.001）更大，玻璃体内活动种子的比例（29%对 55%，P = 0.01）和总视网膜脱离的比例（10%对 43%，P < 0.001）更高。两组均无 A 组病例。B、C 和 E 组的眼球保存率无显著差异，但 D 组 IAC 治疗的眼球保存率显著提高（48%对 91%，P = 0.004）。IAC 治疗在实性肿瘤（62%对 92%，P = 0.002）、视网膜下种子（31%对 86%，P = 0.006）和玻璃体内种子（25%对 74%，P = 0.006）的控制效果显著优于 IVC。两组均无松果体母细胞瘤、第二肿瘤、转移或死亡病例。
结论
对于单侧视网膜母细胞瘤，与 IVC 相比，IAC 可为 D 组患者提供显著更好的眼球保存率。此外，IAC 还可为实性肿瘤、视网膜下种子和玻璃体内种子提供更好的控制效果。
Zotero 插件