眼内晚期视网膜母细胞瘤静脉化学治疗失败后行眼动脉介入化学治疗的疗效观察  

Efficacy of intra-arterial chemotherapy for advanced retinoblastoma after failure of intravenous chemotherapy

作　　者：季迅达[1] 李家恺[1] 赵军阳[3] 张靖 华续明[2] Carol L. Shields 赵培泉[1] 

机构地区：[1]上海交通大学医学院附属新华医院眼科,200092 [2]上海交通大学医学院附属新华医院神经外科,200092 [3]首都医科大学附属北京儿童医院眼科 [4]广州市妇女儿童医疗中心介入血管瘤科 [5]美国费城Wills眼科医院

出　　处：《中华眼底病杂志》2015年第6期556-559,共4页Chinese Journal of Ocular Fundus Diseases

基　　金：国家自然科学基金（81271045、81470642）

摘　　要：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％。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 RB 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.

关 键 词：视网膜母细胞瘤/药物疗法 化学疗法 肿瘤 局部灌注 治疗结果 

分 类 号：R739.72[医药卫生—肿瘤]