From the Department of Neurosurgery (A.S., J.H.W., V.X., K.S., M.P.B., S.D., S.R., S.T., P.J.), Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania.
Department of Pediatric Endocrinology (B.H.), Children Hospital of Philadelphia, Philadelphia, Pennsylvania.
AJNR Am J Neuroradiol. 2020 Jul;41(7):1286-1292. doi: 10.3174/ajnr.A6590. Epub 2020 Jun 25.
Intra-arterial chemotherapy for retinoblastoma has dramatically altered the natural history of the disease. The remarkable outcomes associated with a high safety profile have pushed the envelope to offer treatment for patients weighing ≤10 kg. The purpose was to determine the efficacy and safety of IAC infusions performed in infants weighing ≤10 kg with intraocular retinoblastoma.
A retrospective chart review was performed for patients diagnosed with retinoblastoma and managed with intra-arterial chemotherapy.
The total study cohort included 207 retinoblastoma tumors of 207 eyes in 196 consecutive patients who underwent 658 intra-arterial chemotherapy infusions overall. Of these, patient weights were ≤10 kg in 69 (35.2%) and >10 kg in 127 (64.8%) patients. Comparison (≤10 kg versus >10 kg) revealed that the total number of intra-arterial chemotherapy infusions was 222 versus 436. Periprocedural complications were not significantly different (2 [0.9%] versus 2 [0.5%]; = .49). Cumulative radiation exposure per eye was significantly lower in infants weighing ≤10 kg (5.0 Gym versus 7.7 Gym; = .01). Patients weighing ≤10 kg had a greater frequency of complete tumor regression (82.6% versus 60.9%; = .02). Mean fluoroscopy time was not significantly different (7.5 versus 7.2; = .71). There was a significant difference in the frequency of enucleation (16 [21.6%] versus 52 [39.1%]; = .01). Patients weighing ≤10 kg had greater number of aborted procedures (12 [5.4%] versus 7 [1.6%]; = .01). On multivariate analysis, weight ≤10 kg was not an independent predictor of complications or procedure failure.
Intra-arterial chemotherapy in patients weighing ≤10 kg is a safe and effective treatment.
眼内动脉化疗（intra-arterial chemotherapy，IAC）显著改变了视网膜母细胞瘤（retinoblastoma）的自然病程。由于其具有较高的安全性且治疗效果显著，该疗法的应用范围已扩展到治疗体重≤10kg 的患儿。本研究旨在评估 IAC 治疗体重≤10kg 的眼内期视网膜母细胞瘤患儿的有效性和安全性。
回顾性分析接受 IAC 治疗的视网膜母细胞瘤患儿的临床资料。
共有 196 例连续患儿的 207 只眼接受了 IAC 治疗，共进行了 658 次 IAC 输注。其中 69 例（35.2%）患儿的体重≤10kg，127 例（64.8%）患儿的体重＞10kg。结果显示，两组患儿的 IAC 输注次数分别为 222 次和 436 次，差异无统计学意义（ =.49）。两组患儿的围手术期并发症发生率差异无统计学意义（2 例[0.9%]与 2 例[0.5%]； =.49）。与体重＞10kg 的患儿相比，体重≤10kg 的患儿每只眼的累积辐射暴露量显著降低（5.0Gy 比 7.7Gy； =.01）。前者的完全肿瘤消退率显著更高（82.6%比 60.9%； =.02）。两组患儿的平均透视时间差异无统计学意义（7.5 秒比 7.2 秒； =.71）。前者的眼球摘除率显著更高（16 例[21.6%]比 52 例[39.1%]； =.01）。此外，前者的手术中断率也显著更高（12 例[5.4%]比 7 例[1.6%]； =.01）。多因素分析结果显示，体重≤10kg 并不是并发症或手术失败的独立预测因素。
体重≤10kg 的患儿行 IAC 治疗是一种安全有效的治疗方法。
