Chawla Bhavna, Jain Amit, Seth Rachna, Azad Rajvardhan, Mohan V K, Pushker Neelam, Ghose Supriyo
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Department of Pediatrics, Pediatric Oncology Division, All India Institute of Medical Sciences, New Delhi, India.
Indian J Ophthalmol. 2016 Jul;64(7):524-9. doi: 10.4103/0301-4738.190143.
To prospectively study the clinical outcome and regression patterns of early retinoblastoma (Groups A and B) after systemic chemotherapy and focal consolidation in Indian children.
Group A eyes were treated with focal therapy (transpupillary thermotherapy/cryotherapy) and Group B with systemic chemoreduction and focal therapy. Outcome measures were efficacy and safety of treatment, risk factors for treatment failure, regression patterns, and factors predictive of regression patterns.
Of 119 eyes (216 tumors), 14 (11.8%) were Group A and 105 (88.2%) were Group B eyes. The mean follow-up was 22.6 months. Tumor control was achieved in 111/119 eyes (93.3% overall, 100% Group A, 92.4% Group B). Eight Group B eyes (6.7%) had treatment failure. No serious systemic side-effects were noted. Risk factors for failure included larger tumors (P = 0.001) and proximity to posterior pole (P = 0.014). Regression patterns were Type 4 (50.2%), Type 3 (31.7%), Type 1 (11.1%), and Type 2 (7%). Factors predictive of Type 4 regression were smaller tumors, anterior location, younger age; Type 3 regression was associated with larger tumors, macular location, and older age.
Systemic chemoreduction and focal therapy provided effective tumor control in Indian children. Factors predictive of regression patterns included age, tumor size and its location, and the modality of treatment.
前瞻性研究印度儿童早期视网膜母细胞瘤（A组和B组）在全身化疗和局部巩固治疗后的临床结局及消退模式。
A组眼睛采用局部治疗（经瞳孔温热疗法/冷冻疗法），B组采用全身化疗减瘤和局部治疗。结局指标包括治疗的有效性和安全性、治疗失败的危险因素、消退模式以及预测消退模式的因素。
119只眼睛（216个肿瘤）中，14只（11.8%）为A组眼睛，105只（88.2%）为B组眼睛。平均随访时间为22.6个月。111/119只眼睛（总体93.3%，A组100%，B组92.4%）实现了肿瘤控制。8只B组眼睛（6.7%）治疗失败。未观察到严重的全身副作用。失败的危险因素包括较大的肿瘤（P = 0.001）和靠近后极（P = 0.014）。消退模式为4型（50.2%）、3型（31.7%）、1型（11.1%）和2型（7%）。预测4型消退的因素是较小的肿瘤、前部位置、较年轻的年龄；3型消退与较大的肿瘤、黄斑位置和较年长的年龄相关。
全身化疗减瘤和局部治疗为印度儿童提供了有效的肿瘤控制。预测消退模式的因素包括年龄、肿瘤大小及其位置以及治疗方式。
