中国实用眼科杂志
中國實用眼科雜誌
중국실용안과잡지
CHINESE JOURNAL OF PRACTICAL OPHTHALMOLOGY
2012年
3期
310-314
,共5页
罗鑫%杜毅%叶慧菁%马文芳%杨华胜
囉鑫%杜毅%葉慧菁%馬文芳%楊華勝
라흠%두의%협혜정%마문방%양화성
视网膜母细胞瘤%眼眶侵犯%全身化疗%局部化疗
視網膜母細胞瘤%眼眶侵犯%全身化療%跼部化療
시망막모세포류%안광침범%전신화료%국부화료
Retinoblastoma%Orbital Involvement%Systemic Chemotherapy%Local Chemotherapy
目的 探讨全身化疗联合局部化疗对视网膜母细胞瘤(Rb)眼眶侵犯患者的临床效果.方法 从2009年2月到2011年1月,中山大学中山眼科中心诊断的17例17只眼影像学显示明显Rb眼眶侵犯患者,接受CEV方案(卡铂、依托泊甙和长春新碱)全身化疗联合卡铂眶周注射治疗.其中12例(原发眼眶侵犯9例,继发眼眶侵犯3例)诊断后立即联合化疗;其余5例(原发眼眶视神经侵犯)先行眼球摘除术再用联合化疗.结果 所有患者对术前化疗有明显反应.9例原发眼眶侵犯的患者中,8例在联合化疗后3个疗程行眼球摘除术,7例术后病理回报肿瘤坏死或限于球内,1例回报视神经断端肿瘤浸润;另1例仅联合化疗后6个月复发视神经侵犯,行眼球摘除术病理显示视神经断端肿瘤浸润.3例继发眼眶侵犯的患者对联合化疗有完全反应.随访时间平均12.5个月(7~23个月).7例因中枢神经系统转移死亡.13个月的生存率为48.5%.结论 采用全身化疗联合眼局部化疗对眼眶视网膜母细胞瘤是有效的,有可能替代眶内容剜除术和眼外放疗.
目的 探討全身化療聯閤跼部化療對視網膜母細胞瘤(Rb)眼眶侵犯患者的臨床效果.方法 從2009年2月到2011年1月,中山大學中山眼科中心診斷的17例17隻眼影像學顯示明顯Rb眼眶侵犯患者,接受CEV方案(卡鉑、依託泊甙和長春新堿)全身化療聯閤卡鉑眶週註射治療.其中12例(原髮眼眶侵犯9例,繼髮眼眶侵犯3例)診斷後立即聯閤化療;其餘5例(原髮眼眶視神經侵犯)先行眼毬摘除術再用聯閤化療.結果 所有患者對術前化療有明顯反應.9例原髮眼眶侵犯的患者中,8例在聯閤化療後3箇療程行眼毬摘除術,7例術後病理迴報腫瘤壞死或限于毬內,1例迴報視神經斷耑腫瘤浸潤;另1例僅聯閤化療後6箇月複髮視神經侵犯,行眼毬摘除術病理顯示視神經斷耑腫瘤浸潤.3例繼髮眼眶侵犯的患者對聯閤化療有完全反應.隨訪時間平均12.5箇月(7~23箇月).7例因中樞神經繫統轉移死亡.13箇月的生存率為48.5%.結論 採用全身化療聯閤眼跼部化療對眼眶視網膜母細胞瘤是有效的,有可能替代眶內容剜除術和眼外放療.
목적 탐토전신화료연합국부화료대시망막모세포류(Rb)안광침범환자적림상효과.방법 종2009년2월도2011년1월,중산대학중산안과중심진단적17례17지안영상학현시명현Rb안광침범환자,접수CEV방안(잡박、의탁박대화장춘신감)전신화료연합잡박광주주사치료.기중12례(원발안광침범9례,계발안광침범3례)진단후립즉연합화료;기여5례(원발안광시신경침범)선행안구적제술재용연합화료.결과 소유환자대술전화료유명현반응.9례원발안광침범적환자중,8례재연합화료후3개료정행안구적제술,7례술후병리회보종류배사혹한우구내,1례회보시신경단단종류침윤;령1례부연합화료후6개월복발시신경침범,행안구적제술병리현시시신경단단종류침윤.3례계발안광침범적환자대연합화료유완전반응.수방시간평균12.5개월(7~23개월).7례인중추신경계통전이사망.13개월적생존솔위48.5%.결론 채용전신화료연합안국부화료대안광시망막모세포류시유효적,유가능체대광내용완제술화안외방료.
Objective To study the effect of systemic chemotherapy and periocular carboplatin injection for orbital involvement of retinoblastoma. Methods Retrospective evaluation of 17 patients who were diagnosed and treated at the Zhongshan Ophthalmic Center,Sun Yat-Sen University (Guangzhou,China) between February 2009 and January 2011 for overt orbital involvement of retinoblastoma.They were treated by combined chemotherapy consists of intravenous chemotherapy with a CEV regimen (carboplatin,etoposide and vincristine) and local chemotherapy with periocular carboplatin injection.Of 12 patients (9 with primary orbital retinoblastoma,3 with secondary orbital retinoblastoma) received combined chemotherapy immediately after the diagnosis of orbital involvement,and the other 5 patients with primary optic nerve enlargement were enucleated upfront. Results All 12 patients who had combined chemotherapy immediately presented obvious clinical response,In which the 3 patients with secondary orbital retinoblastoma presented complete clinical response.Among the 9 patients with primary orbital retinoblastoma,8 patints were enucleated immediately after combined chemotherapy,the pathologic examination showed no viable tumor or tumor was limited to eyeball in 7patients,the optic nerve section were involved in 1 patients.Another patient relapsed in optic nerve at 6 months after refusing enucleation.Then surgery was operated,and the pathologic examination showed the optic nerve section was involved.Seven patients dead of CNS metastase in the follow-up of median 12.5 months (range 7~23).The probability of event-free survival was 48.5% at 13 months.Conclusions Systemic chemotherapy combined with local carboplatin injection is effective in orbital involvement of retinoblastoma.Which maybe replace the orbital exenteration and radiotherapy.