Wai Yong Zheng, Radhakrishnan Dhanya Menon, Lingam Ganeshwara, Hamzah Norhafizah, Rahmat Jamalia
Department of Ophthalmology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
Department of Pediatric Ophthalmology, Tunku Azizah Hospital, Kuala Lumpur, Malaysia.
Taiwan J Ophthalmol. 2023 Apr 28;13(4):527-534. doi: 10.4103/tjo.TJO-D-22-00162. eCollection 2023 Oct-Dec.
We aimed to analyze our 4-year experience of intra-arterial chemotherapy (IAC) for retinoblastoma (RB) and to examine the tumor response, globe salvage, mortality, and safety profile of IAC in the Malaysian profile.
This was a retrospective, interventional case series. A total of 22 eyes of 20 patients with RB who underwent IAC using melphalan and topotecan from January 2018 to December 2021 in Hospital Kuala Lumpur were retrospectively reviewed. Tumor response, globe salvage, mortality, and safety profile of IAC were compared based on the International Classification of Retinoblastoma.
The mean patient age at IAC was 21.3 months. An overall globe salvage rate of 63.6% was observed: more specifically, 100% for Group A, 75% for Groups B and C, 66.7% for Group D, and 42.9% for Group E. Poor tumor response after IAC was significantly associated with a lesser chance of globe salvage ( = 0.045). The overall rate of good tumor response following IAC was 77.3%. Specifically, rates of good tumor response in each group were 100%, 75%, 75%, 83.3% and 71.4% in group A, B, C, D and E, respectively. The mortality rate was 5%. Complications (per-catheterization) included cerebral infarct (2.2%), oxygen desaturation (2.2%), vomiting (26.1%), periorbital edema (8.8%), ptosis (6.5%), fever, femoral hematoma, and hyperpigmentation over lid (4.4% each).
Four-year experience showed that IAC is a safe and effective method for RB management. Patients with a poor response after IAC may have a lower chance of globe salvage. Careful patient selection is of utmost importance to achieve the best outcome in a setting of limited health-care resources.
我们旨在分析我们在马来西亚对视网膜母细胞瘤（RB）进行动脉内化疗（IAC）的4年经验，并研究IAC的肿瘤反应、眼球挽救率、死亡率和安全性。
这是一项回顾性、干预性病例系列研究。回顾性分析了2018年1月至2021年12月在吉隆坡医院接受美法仑和拓扑替康IAC治疗的20例RB患者的22只眼。根据视网膜母细胞瘤国际分类比较IAC的肿瘤反应、眼球挽救率、死亡率和安全性。
IAC时患者的平均年龄为21.3个月。观察到总体眼球挽救率为63.6%：具体而言，A组为100%，B组和C组为75%，D组为66.7%，E组为42.9%。IAC后肿瘤反应不佳与眼球挽救机会较低显著相关（P = 0.045）。IAC后良好肿瘤反应的总体发生率为77.3%。具体而言，A、B、C、D和E组的良好肿瘤反应率分别为100%、75%、75%、83.3%和71.4%。死亡率为5%。并发症（每次插管）包括脑梗死（2.2%）、氧饱和度下降（2.2%）、呕吐（26.1%）、眶周水肿（8.8%）、上睑下垂（6.5%）、发热、股部血肿和眼睑色素沉着（各4.4%）。
4年的经验表明，IAC是一种安全有效的RB治疗方法。IAC后反应不佳的患者眼球挽救机会可能较低。在医疗资源有限的情况下，仔细选择患者对于取得最佳治疗效果至关重要。
