视网膜母细胞瘤患者全身化学药物治疗联合眼部治疗的临床疗效观察

Therapeutic effect of chemotherapy combined with ophthalmic therapy on retinoblastoma

目的观察视网膜母细胞瘤（RB）患者全身化学药物治疗（化疗）联合眼部治疗的临床效果。方法回顾分析37例56只眼行全身化疗联合眼部治疗的RB患者的生存率、眼球保留率以及病情得到良好控制的情况。病情得到良好控制的标准为：（1）眼部肿瘤缩小乃至消失,肿瘤病灶呈软乳酪样改变或出现钙化和瘢痕化;（2）眼球摘除者未出现眼眶肿瘤复发;（3）临床检查未见肿瘤转移。所有患者均至少有一只肿瘤眼分期为b期或以上并接受化疗。根据肿瘤对化疗的反应情况,一般接受6轮全身化疗,每轮化疗间隔3～4周。化疗药物组成为：长春新碱、环磷酰胺、依托泊甙（VP16）、卡铂。另外,根据情况分别联合激光光凝、冷冻、经瞳孔温热疗法（TTT）、钌^106放射敷贴器局部放射治疗以及眼球摘除等眼部治疗。治疗和观察时间2～59个月,平均观察时间为35个月。结果除1例双眼发病患者眼球摘除手术后失访外,观察期内30例患者存活,占83.3%;6例患者死亡,占16.6%。30例存活患者的45只肿瘤眼中,肿瘤分期为-期（早期）、-期（中期）和期（晚期）者眼球保存率分别为100%（10只眼）、70.0%（10只眼）和14.3%（21只眼）,随访期内病情均得到良好控制。6例死亡患者均为肿瘤分期期以上,最终死于肿瘤脑转移。结论全身化疗联合多种眼部治疗可以有效地治疗RB。

Objective To observe the therapeutic efficacy of chemotherapy combined with ophthalmic therapy on retinoblastoma （RB）. Methods The survival rate, eye ball remaining rate, and the control of the disease condition of 37 patients （56 eyes） with RB were retrospectively analyzed. The standard of the well control of the disease included： （1） the ocular tumor shrank or even disappeared, and the tumor had cream-like changes or calcification and cicatrisation; （2） no ocular tumor recurrence in patients who had undergone enucleation; （3） no metastasis found in the follow-up period. All of the patients had at least one eye with RB （≥Ⅲ b stage） underwent chemotherapy. According to the response of the tumor to the chemotherapy, the patients generally underwent 6 times of systemic chemotherapy at regular intervals of 3-4 weeks. The medicines for chemotherapy included vincristine, cyclohosphamide, etoposide phosphate, and carboplatin. According to the self condition, the patients underwent chemotherapy combined with several ophthalmic therapies like photocoagulation, cryotherapy, transpupillary thermotherapy, 106Ru brachytherapy, enucleation, etc. The observation duration lasted 2- 59 months, with the average of 35 months. Results Thirty patients （83.3%） survived and were followed up, and 6 died （16. 6%）. One patient with bilateral tumor couldn＇t be followed up after enucleation of both eyes. Among these 30 patients （45 eyes）, eye ball remaining rate at stage Ⅰ - Ⅱ , Ⅲ - Ⅳ , and Ⅴ was 100% （10 eyes）, 70% （10 eyes）, and 14.3% （21 eyes）, respectively. In the follow-up duration, the disease in all of the 30 patients was controlled well, Conclusions Chemotherapy combined with ophthalmic therapy is effective on RB.