经眼动脉灌注化疗对年龄≤6个月血管纤细的视网膜母细胞瘤患儿的临床疗效及安全性  

Clinical efficacy and safety of intra-arterial chemotherapy for the treatment of young infants with retinoblastoma

作　　者：姜华 方倩 邓海浪 罗芳 刘珍银 夏杰军 陈妙娟 蒋贻洲 张靖 JIANG Hua;FANG Qian;DENG Hai Lang;LUO Fang;LIU Zhen Yin;XIA Jie Jun;CHEN Miao Juan;JIANG Yi Zhou;ZHANG Jing(the Guangzhou Women and Children’s Medical Center,Guangzhou 510120,Guangdong Province,China)

机构地区：[1]广州市妇女儿童医疗中心,广东省广州市510120

出　　处：《眼科新进展》2017年第12期1143-1145,1149,共4页Recent Advances in Ophthalmology

基　　金：广东省自然科学基金资助(编号:2015A030313878)~~

摘　　要：目的评估经眼动脉灌注化疗(intra-arterial chemotherapy,IAC)对年龄≤6个月血管纤细的视网膜母细胞瘤患儿的临床疗效及安全性。方法回顾性分析2013年1月至2017年2月我科收治的经IAC治疗的年龄≤6个月的眼内期视网膜母细胞瘤患儿21例24眼。依照国际眼内视网膜母细胞瘤分期,24眼中B期4眼、D期13眼、E期7眼。化疗采用两种给药方式,第一次及第三次IAC给予美法仑联合卡铂(20 mg)灌注化疗,第二次及第四次IAC则给予美法仑联合拓扑替康(0.5~1.0 mg)灌注化疗,其中美法仑的剂量不超过0.5 mg·kg^(-1),同时根据前一次IAC后患儿反应以及瘤体的变化情况适当调节美法仑的剂量。主要观察指标包括技术成功率、保眼率、局部以及全身并发症、射线曝光时间及剂量。结果 21例患儿69次IAC术共行70次眼动脉插管,技术成功率为98.6%,1次因眼动脉痉挛插管失败。患儿IAC次数2~4次,平均3.3次。经过IAC术后,17眼肿瘤最后呈鱼肉样改变或钙化或形成瘢痕组织,保眼率为70.8%,其余7眼(29.2%)行眼球摘出术,其中眼球摘出原因包括眼底出血3眼、广泛玻璃体种植4眼。术后,轻微局部并发症包括8例眼睑肿胀,患者自行恢复;严重并发症中眼底出血3例、眼动脉痉挛1例,其中眼底出血患儿行眼球摘出,其他患儿对症治疗得以缓解;9例出现骨髓抑制,对症处理后好转或自行恢复。单次IAC术中患儿接受射线照射时间为3.2~32.4(6.3±1.2)min,单次IAC照射剂量为9~153(51.9±9.2)mG y。单人IAC累计照射时间为6.6~53.1(19.2±0.9)min;单人IAC累计照射剂量为41~281(157.3±13.1)mG y。结论 IAC治疗年龄≤6个月血管纤细的视网膜母细胞瘤患儿安全有效,IAC术中的放射剂量低于引起晶状体组织反应的吸收剂量阈值。ObjectiveTo assess the safety and efficacy of intra arterial chemotherapy(IAC)for the treatment of young infants(≤6months)with retinoblastoma(RB).MethodsTogether21(24eyes)young infants(≤6months)with RB who received IAC were included from January2013to February2017in this study and the clinical data were retrospectively analyzed.According to the international stages for intraocular retinoblastoma,stage B appeared in4eyes,stage D in13eyes,and stage E in7eyes.And there were two kinds of administration for chemotherapy,including perfusion chemotherapy of melphalan(≤0.5mg·kg-1)combined carboplatin(20mg)on the first and third IAC procedures,and melphalan(≤0.5mg·kg-1)combined with topotecan(0.5-1.0mg)on the second and fourth IAC procedures,and the dose of melphalan was appropriately adjusted according to the tumor changes and the response of the child after the previous IAC.Then main outcome measures include successful rate for procedures,ocular preservation rate,local and systemic complications and the time and dose of radiation exposure during IAC were evaluated.ResultsOf the70IAC procedures performed on24eyes,69procedures(98.6%)were successful,and1was failed due to ophthalmic spasm.IAC ranged from2to4cycles with mean3.3cycles.After IAC procedures,17eyes presented fish like changes or calcification or scar formation,and the overall ocular preservation rate was70.8%,and the other7eyes(29.2%)underwent enucleation of the eyeballs due to fundus hemorrhage in3eyes and extensive vitreous implantation in4eyes.Postoperative adverse reactions included eyelid oedema in8patients,fundus hemorrhage in3eyes,ocular arteriospasm in1patients and bone marrow suppression in9patients.The mean irradiation time was3.2-32.4(6.3±1.2)min for one IAC procedure and the mean irradiation dose was5-153(51.9±9.2)mGy.The cumulative irradiation time was6.6-53.1(19.2±0.9)min for each patient of IAC cycles and the cumulative irradiation dose was41-281(157.3±13.1)mGy.ConclusionIAC is safe and effective for the treatment of young infants(�

关 键 词：视网膜母细胞瘤 经眼动脉灌注化疗术 保眼率 

分 类 号：R739.7[医药卫生—肿瘤]