From the Departments of Radiology (T.A., J.M.R.)
Departments of Neurosurgery (T.A.).
AJNR Am J Neuroradiol. 2021 Jan;42(2):354-361. doi: 10.3174/ajnr.A6905. Epub 2020 Dec 24.
Selective ophthalmic artery infusion chemotherapy has improved ocular outcomes in children with retinoblastoma. Our aim was to correlate quantitative tumor reduction and dichotomous therapeutic response with technical and adjunctive factors during selective ophthalmic artery infusion chemotherapy for retinoblastoma. An understanding of such factors may improve therapeutic efficacy.
All patients with retinoblastoma treated by selective ophthalmic artery infusion chemotherapy at a single center during a 9-year period were reviewed. Only first-cycle treatments for previously untreated eyes were studied. Adjunctive factors (intra-arterial verapamil, intranasal oxymetazoline external carotid balloon occlusion) and technical factors (chemotherapy infusion time, fluoroscopy time) were documented by medical record review. Quantitative tumor reduction was determined by blinded comparison of retinal imaging acquired during examination under anesthesia before and 3-4 weeks after treatment. The dichotomous therapeutic response was classified according to quantitative tumor reduction as satisfactory (≥ 50%) or poor (<50%).
Twenty-one eyes met the inclusion criteria. Patients ranged from 2 to 59 months of age. Adjuncts included intra-arterial verapamil in 15, intranasal oxymetazoline in 14, and external carotid balloon occlusion in 14. Quantitative tumor reduction ranged from 15% to 95%. Six showed poor dichotomous therapeutic response. A satisfactory dichotomous therapeutic response was correlated with intra-arterial verapamil ( = .03) in the aggregate cohort and in a subgroup undergoing treatment with single-agent melphalan at a dose of <5 mg ( = .02). In the latter, higher average quantitative tumor reduction correlated with intra-arterial verapamil ( < .01).
Intra-arterial verapamil during selective ophthalmic artery infusion chemotherapy is correlated with an improved therapeutic response, particularly when treating with lower doses of single-agent melphalan.
选择性眼动脉灌注化疗改善了儿童视网膜母细胞瘤的眼部预后。本研究旨在分析视网膜母细胞瘤选择性眼动脉灌注化疗过程中的定量肿瘤退缩与二分类治疗反应与技术和辅助因素之间的关系。了解这些因素可能有助于提高治疗效果。
回顾性分析了 9 年间在单中心接受选择性眼动脉灌注化疗的所有视网膜母细胞瘤患者资料。仅纳入初治眼的首周期治疗患者。通过病历回顾记录辅助因素（动脉内维拉帕米、鼻内羟甲唑啉、颈外动脉球囊阻断）和技术因素（化疗输注时间、透视时间）。通过在全身麻醉下检查获得的视网膜成像，在治疗前和 3-4 周后进行盲法比较，确定定量肿瘤退缩。根据定量肿瘤退缩将治疗反应分为满意（≥50%）和不满意（<50%）。
共 21 只眼符合纳入标准，患者年龄 2-59 个月。15 只眼使用了动脉内维拉帕米，14 只眼使用了鼻内羟甲唑啉，14 只眼使用了颈外动脉球囊阻断。定量肿瘤退缩范围为 15%-95%。6 只眼治疗反应不佳。总体和接受单药氨甲喋呤（<5mg）治疗的亚组中，联合应用动脉内维拉帕米与治疗反应的二分类结果呈正相关（ =.03）。在该亚组中，较高的平均定量肿瘤退缩与动脉内维拉帕米呈正相关（ < .01）。
选择性眼动脉灌注化疗时应用动脉内维拉帕米与治疗反应改善相关，尤其在接受单药氨甲喋呤低剂量治疗时。
