视网膜母细胞瘤眼球摘除术后放化疗对生存预后影响的研究

Prognosis of postenucleation adjuvant therapy in retinoblastoma

目的探讨视网膜母细胞瘤(Rb)眼球摘除术后辅助治疗对预后的影响研究。方法随访中山大学中山眼科中心1997年1月-2001年12月Rb 102例眼球摘除术或眶内容摘除术,术后进行辅助治疗的64例的生存情况,术后放疗、化疗对生存预后影响的研究。结果筛板后侵犯者25例,进行辅助治疗19例,21例存活,4例死亡;视神经断端侵犯者7例,均给以术后辅助治疗,1例存活,6例死亡;小部分脉络膜侵犯44例,35例术后给以辅助治疗,36例存活,8例死亡;大部分脉络膜侵犯6例,3例进行术后辅助治疗,3例存活,3例死亡;眼前段受侵犯16例,8例术后给以辅助治疗,10例存活,6例死亡;眶组织侵犯12例,辅助治疗11例,4例存活,8例死亡。结论视神经断端侵犯者预后很差,术后积极的辅助治疗生存率很低;眶组织侵犯者眶内容摘除术后放疗对生存预后有帮助;单纯眼前段侵犯者术后辅助治疗要审慎;脉络膜侵犯和视神经近端侵犯者的术后辅助治疗仍需进一步研究。

Objective To study the prognosis of adjuvant therapy after enucleation in retinoblastoma. Methods Following up the survival data of 102 cases of retinoblastoma that were treated by first-line enucleation from Jan 1997.to Dec 2001.In which 64 cases be accepted adjuvant therapy in addition.The influence of radiotherapy and/or chemotherapy on the prognosis was studied. Results There were 25 cases with postlaminar invasion and among them 19 cases had adjuvant therapy.21 cases were survived and 4 cases were died.7 cases with optic nerve resection line invasion which were had adjuvant therapy.There were 6 cases died and 1 alive.There were 35 cases with adjuvant therapy within 44 cases with minimal chroidal invasion which had 36 cases survived and 8 cases died.There were 3 cases with adjuvant therapy within 6 cases with maximal chroidal invasion which had 3 cases survived and 3 died.There were 8 cases with adjuvant therapy within 16 cases with anterior chamber invasion which had 10 cases survived and 6 cases died.12 cases with orbital invasion had 8 cases died and 4 cases survived in which 11 cases received adjuvant therapy. Conclusion The prognosis of optic nerve resection line invasion had lowest survival rate.The radiothrerapy had helpful to the prognosis of orbital invasion.It was noticed that only with anterior chamber invasion the adjuvant therapy should be scrupulosity.There still need more work on the adjuvant therapy for the choroid invasion and postlaminar invasion.