CAJ | 학술논문

目的观察眼动脉介入化学药物治疗(化疗)对静脉化疗失败的眼内晚期视网膜母细胞瘤(RB)的疗效.方法经静脉化疗失败后再行眼动脉介入化疗的眼内晚期RB患儿13例15只眼纳入研究.其中,男性10例,女性3例.平均年龄(15.67±8.16)个月.双眼6例,单眼7例.右眼5只,左眼10只.国际RB分期D期14只眼,占93.33％;E期1只眼,占6.67％.所有患眼均采用长春新碱、依托泊苷和卡铂3药联合的静脉化疗.持续2～8个疗程.静脉化疗后原发视网膜瘤体初步控制后复发3只眼,占20.00％;视网膜下种植灶广泛复发9只眼,占60.00％;玻璃体种植复发2只眼,占13.33％;原发视网膜实性瘤体未能有效控制1只眼,占6.67％.根据患儿年龄、体重和病情选择米尔法兰、拓扑替康和卡铂等药物行眼动脉介入化疗.静脉化疗结束至眼动脉介入化疗开始的时间间隔中位数为3个月.治疗1～5个疗程.治疗结束后随访时间为3～52个月,中位数19个月.观察瘤体控制情况.结果 15只眼中,视网膜瘤体稳定、无有活性的视网膜下或玻璃体种植12只眼,占80.00％;因严重玻璃体种植、广泛视网膜下种植和视网膜瘤体复发导致病情未能有效控制,最终行眼球摘除手术3只眼,占20.00％.无1例发生眼眶或全身转移.结论眼动脉介入化疗对静脉化疗失败的眼内晚期RB有比较好的疗效,保眼率为80.00％.
목적 관찰안동맥개입화학약물치료(화료)대정맥화료실패적안내만기시망막모세포류(RB)적료효.방법 경정맥화료실패후재행안동맥개입화료적안내만기RB환인13례15지안납입연구.기중,남성10례,녀성3례.평균년령(15.67±8.16)개월.쌍안6례,단안7례.우안5지,좌안10지.국제RB분기D기14지안,점93.33％;E기1지안,점6.67％.소유환안균채용장춘신감、의탁박감화잡박3약연합적정맥화료.지속2～8개료정.정맥화료후원발시망막류체초보공제후복발3지안,점20.00％;시망막하충식조엄범복발9지안,점60.00％;파리체충식복발2지안,점13.33％;원발시망막실성류체미능유효공제1지안,점6.67％.근거환인년령、체중화병정선택미이법란、탁복체강화잡박등약물행안동맥개입화료.정맥화료결속지안동맥개입화료개시적시간간격중위수위3개월.치료1～5개료정.치료결속후수방시간위3～52개월,중위수19개월.관찰류체공제정황.결과 15지안중,시망막류체은정、무유활성적시망막하혹파리체충식12지안,점80.00％;인엄중파리체충식、엄범시망막하충식화시망막류체복발도치병정미능유효공제,최종행안구적제수술3지안,점20.00％.무1례발생안광혹전신전이.결론 안동맥개입화료대정맥화료실패적안내만기RB유비교호적료효,보안솔위80.00％.
Objective To evaluate the efficacy of intra arterial chemotherapy (IAC) for advanced retinoblastoma (RB) after failure of intravenous chemotherapy (IVC).Methods Fifteen eyes of 13 patients with advanced RB were treated with IAC (1-5 cycles) after failure of IVC (2-8 cycles).The patients included 10 boys and 3 girls, with the mean age of (15.67±8.16) months.Six patients had bilateral RE and 7 patients had unilateral RB.There were 14 eyes (93.33％) in stage D, 1 eye (6.67％) in stage E according to the International Classification of intraocular retinoblastoma.The main reasons for failure of IVC were recurrent primary tumor in 3 eyes (20.00％), subretinal seeds recurrence in 9 eyes (60.00％), viable vitreous seeds in 2 eyes (13.33％) and poor response of primary tumor in 1 eye (6.67％).The mean interval between IVC completion and IAC start was 3 months.The mean follow-up was 19 months (ranged from 3 to 52 months).Results After IVC and secondary IAC, the retinoblastoma and seeds were regressed in 12 eyes (80.00％).Three eyes required enucleation for severe vitreous seeds, subretinal seeds recurrence and primary tumor recurrence.There was no evidence of metastasis in any case, Conclusion IAC can achieve high global salvage rate (80.00％) for patients with advanced retinoblastoma after failure of IVC.