Vanderbilt University School of Medicine, Nashville, Tennessee; Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
Vanderbilt University School of Medicine, Nashville, Tennessee; Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, Tennessee.
Ophthalmol Retina. 2021 May;5(5):479-485. doi: 10.1016/j.oret.2020.08.011. Epub 2020 Aug 24.
The "cavitary" form of retinoblastoma has historically demonstrated minimal treatment response with intravenous chemoreduction, showing less robust regression and less reduction in tumor size. Intra-arterial chemotherapy (IAC) has been reported to more effectively treat retinoblastoma, allowing many previously unsalvageable eyes to now be saved. The purpose was to report treatment response of cavitary retinoblastoma tumors to IAC.
Retrospective case series.
Patients presenting with cavitary retinoblastoma who were treated with IAC.
Retrospective case series of all patients presenting with cavitary retinoblastoma between August 2014 and January 2019 who were treated with primary IAC.
Tumor regression, recurrence, resolution of vitreous and subretinal seeds, number of treatments required, globe salvage, metastasis, and death.
Eight cavitary retinoblastoma tumors in 6 eyes of 4 patients were treated with IAC. One hundred percent of the cavitary tumors regressed (8/8 tumors, in 6/6 eyes), and 100% of vitreous and subretinal seeds regressed, with 100% globe salvage. None of the tumors recurred, no patients developed metastases, and no patients died. Eyes were treated with a median of 4.5 cycles of IAC (range, 1-7), with fewer IAC treatments used in the later patients (1-3 treatments per eye for the most recent 3 eyes, compared with 6-7 treatments per eye for the earliest 3 eyes). Mean reduction in thickness was 73.4% (range, 59.7%-84.6%). Mean reduction in basal diameter was 45.5% (range, 24.8%-56.0%).
Treatment with IAC results in regression of cavitary retinoblastoma, often with greater reduction in tumor size than has been reported previously with intravenous chemotherapy (IVC). Using up-front triple therapy (e.g., melphalan 0.4 mg/kg, carboplatin 50 mg, and topotecan 2 mg) and noting certain subtle signs of early regression can help to minimize unnecessary additional cycles of treatment.
视网膜母细胞瘤的“空洞型”表现对静脉化疗药物减瘤治疗反应不佳，肿瘤退缩程度和体积缩小程度均不理想。有报道称，动脉内化疗（IAC）能更有效地治疗视网膜母细胞瘤，使许多以前无法挽救的眼睛得以保存。本研究旨在报告空洞型视网膜母细胞瘤肿瘤对 IAC 的治疗反应。
回顾性病例系列。
接受 IAC 治疗的空洞型视网膜母细胞瘤患者。
回顾性分析 2014 年 8 月至 2019 年 1 月期间接受 IAC 治疗的所有空洞型视网膜母细胞瘤患者的病例资料。
肿瘤退缩、复发、玻璃体内和视网膜下种子的消退、所需治疗次数、眼球保存、转移和死亡。
4 名患者的 6 只眼中有 8 个空洞型视网膜母细胞瘤肿瘤接受了 IAC 治疗。所有空洞型肿瘤均完全消退（8/8 个肿瘤，6/6 只眼），玻璃体内和视网膜下种子完全消退，100%的眼球得以保存。无一例肿瘤复发，无一例患者发生转移，无一例患者死亡。所有患者的眼睛接受了中位数为 4.5 个周期的 IAC 治疗（范围为 1-7 个周期），最近 3 只眼的 IAC 治疗次数较少（每只眼 1-3 次），而最早的 3 只眼为 6-7 次。厚度平均减少 73.4%（范围为 59.7%-84.6%）。基底直径平均减少 45.5%（范围为 24.8%-56.0%）。
IAC 治疗可使空洞型视网膜母细胞瘤消退，肿瘤体积缩小程度通常大于静脉化疗药物（IVC）报道的结果。使用初始三联疗法（如美法仑 0.4mg/kg、卡铂 50mg 和拓扑替康 2mg），并注意到早期消退的某些微妙迹象，有助于尽量减少不必要的额外治疗周期。
