经眼动脉灌注化学药物治疗与经静脉全身化学药物治疗对单眼晚期视网膜母细胞瘤的临床疗效初探  

Preliminary study on clinical efficacy of intra-arterial chemotherapy and intravenous chemotherapy for unilateral advanced retinoblastoma

作　　者：刘冬悦 金眉[2] 阴捷[2] 王凤仙[1] 韩立坡[1] 王争[1] 张楠[2] 赵军阳[2] 李莉[2] 张诚玥 Liu Dongyue;Jin Mei;Yin Jie;Wang Fengxian;Han Lipo;Wang Zheng;Zhang Nan;Zhao Junyang;Li Li;Zhang Chengyue(Department of Ophthalmology,Baoding Children’s Hospital,Baoding 071000,China;Beijing Children’s Hospital,Capital Medical University,National Center for Children’s Health,Beijing 100045,China)

机构地区：[1]保定市儿童医院眼科,保定071000 [2]首都医科大学附属北京儿童医院国家儿童医学中心,北京100045

出　　处：《中华眼底病杂志》2022年第3期187-190,共4页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的:对比观察经眼动脉灌注化学药物治疗(IAC)和经静脉全身化学药物治疗(IVC)单眼晚期视网膜母细胞瘤(RB)的疗效及并发症。方法:回顾性临床研究。2020年1月至2021年1月分别于保定市儿童医院眼科和北京儿童医院眼科检查确诊的单眼cT2期RB患儿40例(40只眼)纳入研究。其中,男性22例(22只眼),女性18例(18只眼);均为单眼。根据接受的治疗方案,将患儿分为IAC方案组和IVC方案组,分别为26、14只眼。肿瘤侵犯视神经、脉络膜、巩膜、前房和虹膜时,行眼球摘除手术。观察分析保眼率、肿瘤眼外转移率、实体肿瘤控制率、与治疗相关并发症以及眼球摘除后病理高危因素。组间保眼率、实体肿瘤控制率比较行 χ^(2)检验。 结果:IAC方案组、IVC方案组患儿保眼率分别为88.5% (23/26)、50.0% (7/14);实体肿瘤控制率分别为84.6% (22/26)、42.9% (6/14 )。两组患儿保眼率、实体肿瘤控制率比较,差异均有统计学意义( χ^(2)=7.18、7.56, P<0.05)。与IVC方案组比较,IAC方案组患儿全身并发症更少,眼部和眼周并发症较轻。IAC方案组26例、IVC方案组14例中,最终行眼球摘除分别为3、7例。病理组织检查结果显示,两组存在病理高危因素者分别为2、3例。随访期间,IAC方案组2例均发生肿瘤眼外转移;IVC方案组3例均未出现肿瘤眼外转移。 结论:与IVC比较,IAC对单眼cT2期RB具有肿瘤控制率高、保眼率高、并发症少且轻的优势,但仍存在肿瘤复发。Objective To compare the clinical efficacy and complications of intra-arterial chemotherapy(IAC)and intravenous chemotherapy(IVC)for unilateral advanced retinoblastoma(RB).Methods A retrospective clinical study.From January 2020 to January 2021,40 patients(40 eyes)unilateral group cT2 RB patients diagnosed at Baoding Children’s Hospital and Beijing Children’s Hospital were recruited in this study.There were 22 males(22 eyes)and 18 females(18 eyes).All were monocular.All the patients were assigned to two groups according to different treatment modalities they received:IVC group and IAC group.There were 26 eyes and 14 eyes,respectively.When the tumor invades the optic nerve,choroid,sclera,anterior chamber and iris,enucleation was performed.The globe salvage rate,tumor extraocular metastasis rate,solid tumor control rate,treatment-related complications and pathological high-risk factors after enucleation were observed.The globe salvage rate and solid tumor control rate were compared between the groups by chi square test.Results The globe salvage rate of IAC group and IVC group were 88.5%(23/26)and 50.0%(7/14),respectively.Solid tumor control of IAC group and IVC group were 84.6%(22/26)and 42.9%(6/14),respectively.There were statistically significant differences in globe salvage rate and solid tumor control between the two groups(χ^(2)=7.18,7.56;P<0.05).Compared with IVC group,IAC group had less systemic complications,mild ocular and periocular side effects.Among 26 cases in IAC group and 14 cases in IVC group,3 and 7 cases underwent enucleation respectively.The results of pathological examination showed that there were 2 cases and 3 cases with pathological high-risk factors in the two groups,respectively.During the follow-up period,2 cases in IAC group had extraocular metastasis,there was no extraocular metastasis in IVC group.Conclusion Compared with IVC,IAC has the advantages of high tumor control rate,high globe salvage rate,less and mild complications,however,there is still tumor recurrence.

关 键 词：化学疗法 肿瘤 局部灌注 抗肿瘤联合化疗方案 视网膜母细胞瘤 儿童 

分 类 号：R739.7[医药卫生—肿瘤]