McCormick B, Ellsworth R, Abramson D, Haik B, Tome M, Grabowski E, LoSasso T
Memorial Sloan-Kettering Cancer Center, N.Y., N.Y.
Int J Radiat Oncol Biol Phys. 1988 Sep;15(3):567-74. doi: 10.1016/0360-3016(88)90296-9.
From 1979 through 1986, 170 children were seen at our institution diagnosed with retinoblastoma. Sixty-six of the children with involvement of 121 eyes, were referred for definitive external beam radiation to one or both eyes. During the study period, two distinct radiation techniques were used. From 1980 through mid-1984, a lens-sparing technique included an anterior electron beam with a contact lens mounted lead shield, combined with a lateral field, was used. Since mid-1984, a modified lateral beam technique has been used, mixing lateral electrons and superior and inferior lateral oblique split beam wedged photons. Doses prescribed were similar for both techniques, ranging from 3,850 to 5,000 cGy in 4 to 5 weeks. The lens-sparing and the modified lateral techniques are compared for local control. For eyes with Group I through III disease, the lens-sparing technique resulted in local control in 33% of the eyes treated, where the modified lateral technique controlled 83% of the eyes treated (p = .006). Mean time to relapse was identical in both groups, that is 24 and 26 months respectively. Most relapses were successfully treated with further local therapy, including laser or cryosurgery, or 60Co plaques. Five eyes required enucleation following initial treatment with the lens-sparing technique, but none thus far with the lateral beam technique. For eyes with Group IV and V disease, no significant differences were found between the two techniques in terms of local control or eventual need for enucleation. With a mean follow-up time of 33 months for the entire group, the 4-year survival is 93%. Two of the 4 deaths are due to second primary tumor, and all 4 have occurred in the lens-sparing group. Because follow-up time is more limited in the lateral beam group, this is not statistically significant and direct survival comparisons are premature.
1979年至1986年期间，我院共诊治170例视网膜母细胞瘤患儿。其中66例累及121只眼的患儿被转诊至我院，接受一眼或双眼的确定性外照射放疗。在研究期间，采用了两种不同的放疗技术。1980年至1984年年中，采用了一种晶状体保留技术，即使用带有安装在隐形眼镜上的铅屏蔽的前部电子束，并结合侧野照射。自1984年年中以来，采用了一种改良的侧野照射技术，即混合使用侧方电子束和上下侧斜向分割束楔形光子束。两种技术规定的剂量相似，在4至5周内为3850至5000 cGy。对晶状体保留技术和改良侧野照射技术的局部控制效果进行了比较。对于I至III期疾病的患眼，晶状体保留技术使33%的治疗眼实现了局部控制，而改良侧野照射技术使83%的治疗眼得到了控制（p = 0.006）。两组的平均复发时间相同，分别为24个月和26个月。大多数复发通过进一步的局部治疗成功治愈，包括激光或冷冻手术，或60钴敷贴。在最初采用晶状体保留技术治疗后，有5只眼需要摘除眼球，但到目前为止，采用侧野照射技术治疗的患眼中无一例需要摘除眼球。对于IV期和V期疾病的患眼，两种技术在局部控制或最终摘除眼球的必要性方面没有显著差异。整个研究组的平均随访时间为33个月，4年生存率为93%。4例死亡中有2例是由于第二原发性肿瘤，且均发生在晶状体保留组。由于侧野照射组的随访时间较短，这一差异无统计学意义，直接进行生存比较还为时过早。
