眼内晚期视网膜母细胞瘤患者的临床治疗及观察

Clinical therapeutic effect for advanced intraocular retinoblastoma

目的:晚期眼内视网膜母细胞瘤患者化学减容术联合眼肿瘤局部加强治疗方法的临床观察。方法:对10例15只眼内晚期视网膜母细胞瘤(RB)患儿采用化学减容术联合眼肿瘤局部冷冻和(或)经瞳孔温热疗法(TTT)进行治疗,并对其临床及随访资料进行回顾性分析。化学减容术采用VEC方案即依托泊苷、长春新碱和卡铂。平均随访时间16.4个月。结果:15只患眼均对化学减容术显示出良好初始反应。经第一疗程化疗后,肿瘤基地最大直径平均缩小37.2%;肿瘤厚度平均缩小46.7%。6只眼视网膜下积液部分或完全吸收,11只眼视网膜下肿瘤种植明显减少、消失或钙化。11只眼玻璃体内肿瘤种植明显减少、消失或钙化。治疗期间及治疗后随访期间共有9只眼出现了肿瘤和(或)肿瘤种植的复发和(或)新发,经补充冷冻和(或)TTT治疗后,最终3只眼(3/15)摘除,12只眼得以保留,其中10只眼恢复或保持较好有用视力。10例患者均未发生白血病、肝肾功能及听力损害等严重化学治疗毒性反应。结论:对高度进展的晚期RB,化学减容术在治疗初期显示了良好的初始反应。化学减容术联合眼肿瘤局部加强疗法近期内可有效控制视网膜肿瘤、视网膜下种植及玻璃体内种植;远期疗效有待继续观察。

Objective：To observe the therapeutic effect of chemoreduction treatment combined with focal therapy for advanced intraocular retinoblastoma（RB）. Methods：Fifteen eyes of ten patients with RB underwent chemoreduction treatment conbined with focal croytherapy and （or） transpupillary thermotherapy （TIT）, and the clinical data of the patients were retrospectively analyzed. The vincrisfine,etopeslde, and carboplatin（VEC） were used in the chemoreduction treatment. The average follow-up duration was 16.4 months. Results： All of the 15 eyes with RB had favorable initial reaction in the treatment of chemoreduction. After the first period of chemotherapy, the largest diameter of the tumor fundus decreased 37.2%, and the tumor thickeness averagely reduced 46.7%. The subretinal fluid was absorbed completely or partially in 6 eyes （6/8）; vitreous and subretinal seeds reduced, disappeared or calcified in 11 eyes （11/12） and 11 eyes （11/12） respectively. During the treatment and in the follow-up duration, 9 eyes （9/15） had new tumors and （or） recurrences. Finally, 3 eyes （3/15） were enucleated while 12 eyes （12/15） were saved in which 10 （10/12） recovered or remained good visual acuity. None of 10 patients had serious side effects of chemotheraoy like leukemia, functional damage of liver and kidney, and dysacousia. Conclusioa：Chemoreduction treatment has well initial effect on advanced RB. Chemoreduction treatment combined with local treatment may effectively control the retinal tumor, subretinal seeds and vitreous seeds within a short-term duration. The evaluation of long-term effect of zhe treatment needs further observation.