化学减容治疗眼内期视网膜母细胞瘤

Chemoreduction in the treatment of intraocular retinoblastoma

目的观察眼内期视网膜母细胞瘤患儿接受化学减容治疗的疗效.方法对2000年1月至2004年12月间于中山眼科中心行化学减容治疗眼内期视网膜母细胞瘤的9例患儿10只眼进行观察分析.其中男性5例,女性4例;单侧1例,双侧8例.首次就诊时平均年龄为31个月(11～95个月),首次化疗时平均年龄为36.1个月(11～97个月).结果5只眼(5例患者)化疗效果较好,化疗结束后基底直径平均减少了31.1%(-0.2%～59.3%),厚度平均减少了50.6%(28.6%～83.2%),其中1例在化疗结束18个月后肿瘤复发行眼球摘除,其余4例随访至今(平均20个月)无复发及转移.4只眼在治疗中肿瘤持续长大或出现新的病灶而行摘除眼球;1例因出现脑转移在化疗2个疗程后死亡.眼球保留率为40%.所有9例患者可耐受化疗引起的副作用,无严重并发症发生.结论化学减容对眼内期视网膜母细胞瘤有一定的疗效,是一种有潜力的保守治疗方法.

Objective To evaluate the efficacy of chemoreduction in the treatment of intraocular retinoblastoma. Methods 9 patients （10 eyes） who were seen between January 2000 and Decemeber 2004 in Zhongshan Ophthalmic Center, Sun Yat-sen University, were retrospectively reviewed. There were 5 males and 4 females with an average age of 31 months （ 11-95 months）. All patients but one were bilateral- ly affected. They began chemotherapy at an average age of 36.1 months （ 11-97 months）. Results Tu-mors in five eyes were reduced at approximately 31.1% （ -0.2%-59.3% ） in basal dimension and 50.6% （28.6%-83.2% ） in thickness after the last cycle of chemotherapy. Among these eyes one was enudeated because of tumor relapse 18 months after chemotherapy and the other four showed no sign of relapse or metas-tasis during follow-up time （average 20 months）. Four eyes were enucleated because of progression of the tumor during chemotherapy and one patient died after two cycles of chemotherapy due to intracranial metastasis of the tumor. The eyes were saved by 40%. All patients got no severe complication from chemotherapy.Conclusions Chemoreduction has some effect on intraocular retinoblastoma and is a promising conservative method.