Pediatric Hemato-Oncology Service, Hospital Universitario Austral, Pilar, Argentina.
Hematology-Oncology Service, Hospital JP Garrahan, Buenos Aires, Argentina.
Pediatr Blood Cancer. 2018 Aug;65(8):e27086. doi: 10.1002/pbc.27086. Epub 2018 Apr 25.
The feasibility and results of intraarterial chemotherapy, also termed ophthalmic artery chemosurgery (OAC), for retinoblastoma in less developed countries have seldom been reported.
A retrospective evaluation of a program of OAC in Argentina from 2010 to 2015.
Ninety-seven eyes from 81 patients (61 bilateral) were analyzed. In 35 eyes, OAC was given as primary therapy and in 62 it was used for the treatment of tumors with partial response or those relapsing after systemic chemoreduction with focal therapy or external-beam radiotherapy. Twenty-two primarily treated eyes had group D and 13 groups B/C. A total of 400 procedures were carried out. Chemotherapy used included combinations of melphalan, carboplatin, and topotecan. There was no mortality associated with OAC. Toxicity included fever and neutropenia in five (1.25%), hypotension and bradycardia during anesthesia in two and femoral thrombosis in one, eyelid edema in nine, and neutropenia or thrombocytopenia in 28 cycles. With a median follow-up of 48.7 months (range 12-79), the 3-year probability of event-free survival (pEFS) (enucleation and/or radiotherapy were considered events) was comparable for patients who received first-line therapy and those treated at relapse (0.65 vs. 0.63, P = 0.5). In the former, the pEFS was 0.91 and 0.43 for groups B/C and D, respectively (P = 0.01). Two patients died of extraocular dissemination after refusal of enucleation.
OAC was feasible with low toxicity. pEFS improved in all groups compared to the previous experience with systemic chemotherapy reducing the use of radiotherapy. The overall mortality associated with OAC is comparable to our previous experience with systemic chemoreduction.
在欠发达国家，眼动脉化疗（OAC）治疗视网膜母细胞瘤的可行性和结果鲜有报道。
回顾性评估 2010 年至 2015 年期间在阿根廷开展的 OAC 项目。
共分析了 81 例患者（61 例为双侧）的 97 只眼。35 只眼接受 OAC 作为初始治疗，62 只眼在局部治疗或外照射放疗后肿瘤部分缓解或复发时采用。22 只接受初始治疗的眼为 D 组，13 只为 B/C 组。共进行了 400 次化疗。化疗药物包括氨甲蝶呤、卡铂和拓扑替康。OAC 无相关死亡病例。毒性反应包括 5 例（1.25%）发热和中性粒细胞减少、2 例麻醉期间低血压和心动过缓、1 例股静脉血栓形成、9 例眼睑水肿和 28 个周期的中性粒细胞减少或血小板减少。中位随访时间为 48.7 个月（范围 12-79 个月），初治患者和复发患者的 3 年无事件生存率（pEFS）（眼球摘除和/或放疗视为事件）相当（0.65 比 0.63，P=0.5）。在前者中，B/C 和 D 组的 pEFS 分别为 0.91 和 0.43（P=0.01）。2 例患者因拒绝眼球摘除而发生眼外播散死亡。
OAC 具有较低的毒性且可行。与之前的全身化疗相比，所有组的 pEFS 均有所提高，减少了放疗的应用。与之前的全身化疗相比，OAC 的总体死亡率相当。
