Shields J A, Parsons H, Shields C L, Giblin M E
Ocular Oncology Service, Wills Eye Hospital, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107.
Am J Ophthalmol. 1989 Sep 15;108(3):260-4. doi: 10.1016/0002-9394(89)90116-5.
Between February 1974 and August 1987, we treated 67 retinoblastomas in 47 eyes of 45 patients with cryotherapy (triple freeze-thaw technique). Overall, cryotherapy eradicated 53 (79%) of the tumors, whereas additional treatment with episcleral plaque radiotherapy, external beam radiotherapy, or enucleation was necessary in 14 (21%) of the tumors. Tumor destruction was achieved with one or more cryotherapy treatments in all cases in which the tumor was no greater than 2.5 mm in diameter and 1.0 mm in thickness, and in which the tumor was confined to the sensory retina without seeding into the adjacent vitreous humor. We therefore recommend cryotherapy in such cases. Cryotherapy alone failed in 14 larger tumors, ten of which had clinical evidence of vitreous seeding by tumor cells. Cryotherapy is therefore contraindicated in cases of vitreous seeding or if the tumor exceeds 3.5 mm in diameter and 2.0 mm in thickness. Cryotherapy can be successful for tumors up to 3.5 mm in diameter and 2.0 mm in thickness, but more than one treatment may be necessary.
1974年2月至1987年8月期间，我们采用冷冻疗法（三重冻融技术）对45例患者47只眼中的67例视网膜母细胞瘤进行了治疗。总体而言，冷冻疗法消除了53例（79%）肿瘤，而另外14例（21%）肿瘤需要巩膜外斑块放射治疗、外照射放疗或眼球摘除等额外治疗。在所有直径不大于2.5毫米且厚度不超过1.0毫米、局限于感觉视网膜且未播散至邻近玻璃体腔的肿瘤病例中，通过一次或多次冷冻治疗均实现了肿瘤破坏。因此，我们建议在此类病例中采用冷冻疗法。单独使用冷冻疗法对14例较大肿瘤治疗失败，其中10例有肿瘤细胞玻璃体播散的临床证据。因此，玻璃体播散或肿瘤直径超过3.5毫米且厚度超过2.0毫米的病例禁忌使用冷冻疗法。对于直径达3.5毫米且厚度达2.0毫米的肿瘤，冷冻疗法可能成功，但可能需要不止一次治疗。
