National Retinoblastoma Foundation, Department of Ophthalmic and Facial Plastic Surgery and Ocular Oncology, Centre for Sight Superspeciality Eye Hospital, Hyderabad, Telangana, India.
Indian J Ophthalmol. 2018 Dec;66(12):1833-1838. doi: 10.4103/ijo.IJO_737_18.
Refractory or recurrent vitreous seeds account for a large proportion of failure of eye salvage in retinoblastoma. The purpose of this study is to evaluate the efficacy of periocular topotecan (POT) in the management of vitreous seeds in retinoblastoma.
Retrospective, interventional study of patients with retinoblastoma with vitreous seeds who received POT concurrent with intravenous chemotherapy (IVC).
Thirty-eight eyes of 35 patients received POT. Five eyes (13%) belonged to International Classification of Retinoblastoma group C, 23 eyes (61%) belonged to group D, and 10 eyes (26%) belonged to group E. Primary treatment included IVC with a combination of carboplatin, etoposide, and vincristine for a mean of 6 cycles (median 6; range 6-9). Concurrent to IVC from the fourth cycle onward, all patients received POT. Focal vitreous seeds were present in 20 eyes (53%) which received a mean of 3 injections (median 3; range 1-7). Diffuse vitreous seeds were present in 18 eyes (47%) which received a mean of 4 injections (median 5; range 1-7). At a mean follow-up of 8.5 months (median 5 months; range 1-15 months), regression of focal and diffuse vitreous seeds was achieved in 16 eyes (80%) and 8 eyes (44%), respectively. In all, 24 eyes (63%) had complete remission of vitreous seeds with POT given concurrently with IVC. Eye salvage was possible in 19 eyes (95%) with focal vitreous seeds and 12 eyes (68%) with diffuse VS. Enucleation was necessary for persistent vitreous seeds and viable tumor in five eyes (13%), viable tumor alone in one eye (0.02%), and recurrent vitreous seeds in one eye (0.02%). None of the patients developed systemic metastasis.
POT administered concurrent with IVC is safe and effective in the initial management of vitreous seeds.
玻璃体内复发性或难治性种子是眼保治疗在视网膜母细胞瘤中失败的主要原因。本研究旨在评估眼周拓扑替康（POT）在治疗视网膜母细胞瘤玻璃体内种子中的疗效。
回顾性、干预性研究，纳入了接受 POT 联合静脉化疗（IVC）的玻璃体内种子患者。
35 例患者的 38 只眼接受了 POT 治疗。5 只眼（13%）属于国际视网膜母细胞瘤分类法（ICRB）C 组，23 只眼（61%）属于 D 组，10 只眼（26%）属于 E 组。初始治疗包括 IVC 联合卡铂、依托泊苷和长春新碱，平均治疗 6 个周期（中位数 6；范围 6-9）。从第 4 个周期开始，所有患者同时接受 POT 治疗。20 只眼（53%）存在局灶性玻璃体内种子，平均注射 3 次（中位数 3；范围 1-7）。18 只眼（47%）存在弥漫性玻璃体内种子，平均注射 4 次（中位数 5；范围 1-7）。平均随访 8.5 个月（中位数 5 个月；范围 1-15 个月）后，16 只眼（80%）和 8 只眼（44%）的局灶性和弥漫性玻璃体内种子分别获得消退。共 24 只眼（63%）在接受 IVC 联合 POT 治疗后，玻璃体内种子完全缓解。24 只眼（100%）的局灶性玻璃体内种子和 12 只眼（68%）的弥漫性 VS 保留了眼球。5 只眼（13%）因持续性玻璃体内种子和有活力的肿瘤、1 只眼（0.02%）因单纯有活力的肿瘤、1 只眼（0.02%）因复发性玻璃体内种子而进行了眼球摘除术。无患者发生全身转移。
POT 联合 IVC 治疗是安全有效的，可作为玻璃体内种子的初始治疗方法。
