Shields C L, De Potter P, Himelstein B P, Shields J A, Meadows A T, Maris J M
Ocular Oncology Service, Wills Eye Hospital Service, Thomas Jefferson University, Philadelphia, Pa, USA.
Arch Ophthalmol. 1996 Nov;114(11):1330-8. doi: 10.1001/archopht.1996.01100140530002.
Chemoreduction is a method of reducing tumor volume to allow for more focused, less damaging therapeutic measures.
To determine whether chemoreduction could be used to decrease the size of retinoblastoma so that enucleation or external beam radiotherapy could be avoided and more conservative modalities employed.
A prospective pilot study was performed to assess the effectiveness of a 2-month chemoreduction regimen of vincristine sulfate, etoposide, and carboplatin in patients with retinoblastoma. The study included 20 patients with 54 tumors in 31 eyes.
At the initial examination, the mean tumor base was 12 mm and the thickness, 7 mm. Vitreous seeds were present in 14 eyes (45%). A secondary retinal detachment was present in 24 eyes (77%) and, when present, involved a mean of 71% of the retina. In 11 eyes (36%) the retina was totally detached with serous subretinal fluid. After 2 months of chemoreduction, all 54 tumors showed regression in size, and 48 (89%) showed evidence of calcification. The mean tumor base was 8 mm and the thickness, 4 mm. Overall, there was a mean 35% decrease in base and 49% decrease in thickness of the tumor at the end of the treatment period. A complete response was found in 25 tumors (46%) and a partial response in 29 (54%). The subretinal fluid had resolved completely in 50% of the cases (12/24 eyes), and, in the 11 eyes with total retinal detachment, the subretinal fluid had completely resolved, leaving flat retina, in 6 eyes (54%). The vitreous seeds demonstrated some degree of regression in all cases, and in 5 eyes there was 90% to 100% calcification of the seeds. Short-term systemic toxic effects were mild (transient bone marrow suppression). Enucleation was avoided in all cases; external beam radiotherapy was necessary in 9 eyes because of diffuse vitreous seeds. The remaining 22 eyes were treated with local methods after chemoreduction.
Tumor shrinkage with chemoreduction may allow treatment with less invasive measures, such as cryotherapy, laser photocoagulation, thermotherapy, or plaque radiotherapy, thereby avoiding enucleation and external beam radiotherapy.
化学减容是一种缩小肿瘤体积的方法，以便采取更有针对性、损伤更小的治疗措施。
确定化学减容是否可用于缩小视网膜母细胞瘤的大小，从而避免眼球摘除术或外照射放疗，并采用更保守的治疗方式。
进行一项前瞻性试点研究，以评估硫酸长春新碱、依托泊苷和卡铂的2个月化学减容方案对视网膜母细胞瘤患者的有效性。该研究纳入了20例患者，共31只眼中有54个肿瘤。
在初次检查时，肿瘤基底平均为12mm，厚度为7mm。14只眼（45%）存在玻璃体种植。24只眼（77%）存在继发性视网膜脱离，出现视网膜脱离时，平均累及71%的视网膜。11只眼（36%）视网膜完全脱离并伴有浆液性视网膜下液。化学减容2个月后，所有54个肿瘤大小均缩小，48个（89%）有钙化迹象。肿瘤基底平均为8mm，厚度为4mm。总体而言，治疗期末肿瘤基底平均缩小35%，厚度缩小49%。25个肿瘤（46%）完全缓解，29个（54%）部分缓解。50%的病例（12/24只眼）视网膜下液完全消退，在11只视网膜完全脱离的眼中，6只眼（54%）视网膜下液完全消退，视网膜变平。所有病例中玻璃体种植均有一定程度的缩小，5只眼中种植体钙化90%至100%。短期全身毒性作用较轻（短暂的骨髓抑制）。所有病例均避免了眼球摘除术；9只眼因弥漫性玻璃体种植需要外照射放疗。其余22只眼在化学减容后采用局部治疗方法。
化学减容导致的肿瘤缩小可能允许采用侵入性较小的治疗措施，如冷冻疗法、激光光凝、热疗法或敷贴放疗，从而避免眼球摘除术和外照射放疗。
