晚期视网膜母细胞瘤可否保眼治疗

Eyeball salvage treatment or enucleation for advanced retinoblastoma

在过去的20余年中,视网膜母细胞瘤（RB）的治疗方法发生了巨大的改变,化学治疗改变了RB的治疗理念.目前常用的化学治疗方法包括全身化学治疗、眼动脉化学治疗、玻璃腔注射化学治疗等,成为RB的一线保眼治疗方式.然而,晚期RB的保眼治疗指征并不统一,争议颇多;且当涉及保眼治疗时,很多因素均须考虑,如肿瘤的分期、单双眼、患者依从性及经济因素等.本文通过回顾RB保眼治疗的主要方法与现状,论述国内外对晚期RB保眼治疗的主张,并指出医患双方均不应盲目追求保眼治疗,对于部分晚期RB,摘除眼球仍然不失为一种治疗选择.

The management of retinoblastoma （RB） has dramatically changed over the past two decades.The introduction of chemotherapy has transformed treatment algorithms completely.Chemotherapy is currently used as a first line approach for children with RB and can be delivered by intravenous,intraarterial and intravitreal routes.However,there still remains some controversy on the treatment of advanced RB,especially in eyeball salvage.This article described domestic and international approaches to eyeball salvage treatment.We would like to further discuss our opinion on the management of advanced RB based on our clinical experience for attracting more clinical concern on this issue.Many factors should be considered when choosing the appropriate conservative therapy.The choice of eyeball salvage treatment not only depends upon the tumor staging and laterality but also upon compliance and economic factors.Doctors and parents should not blindly pursue eye saving.However,there are still cases where enucleation is definitely the treatment of choice.