118例视网膜母细胞瘤临床治疗分析

Clinical treatment for retinoblastoma:report of 118 cases

目的探讨118例视网膜母细胞瘤(retinoblastoma,RB)临床治疗特点及预后。方法以2008年2月至2018年2月我科收治的118例RB病例为研究对象,按IIRC(A^E期)和眼外期标准对患眼进行分期,主要根据肿瘤的分期,同时结合患儿身体状况及患儿家长意愿采用静脉化疗、经瞳孔温热疗法(transpupillary thermotherapy,TTT)、冷凝疗法、眼球摘除等方式治疗,随访1~10年,回顾性分析患儿的临床疗效及预后。结果118例患儿共154眼,双眼36例,单眼82例,男性70例,女性48例。初诊患儿年龄1~122(25.94±20.88)个月。化疗41例,化疗联合TTT治疗57例,化疗联合冷凝治疗10例,单纯眼摘10例。154眼治疗后保76眼,总保眼率49.35%(76/154),其中采用化疗联合TTT治疗保47眼,占总保眼数61.84%(47/76)。手术摘除78眼,总摘眼率50.65%(78/154),E期手术摘53眼,占E期患眼84.13%(53/63)。118例患儿随访时间(86.66±5.69)个月,死亡22例,总死亡率18.64%(22/118);存活96例,总存活率81.36%(96/118);单眼RB 5年累积生存率为71.40%,双眼RB 5年累积生存率为80.00%。结论静脉化疗联合TTT治疗是RB患儿保眼球的主要治疗方式,眼球摘除仍然是E期的主要治疗方式,E期RB患儿应慎重选择保眼治疗。

Objective To investigate the characteristics of clinical treatment and prognosis of 118 cases of retinoblastoma(RB).Methods A total of 118 RB children treated in our department from February 2008 to February 2018 were recruited in this study.All of them were evaluated by the International Classification for Intraocular Retinoblastoma(IIRC,A^E stage)and extraocular staging standard.Mainly according to their tumor stage,combined with their physical condition and the wishes of their parents,treatments such as intravenous chemotherapy,transpupillary thermotherapy(TTT),freezing and enucleation were applied.All cases were followed up for 1 to 10 years,and the clinical efficacy and prognosis of the patients were analyzed retrospectively.Results The 118 enrolled children(154 eyes)were 70 males and 48 females,at an average age of 25.94±20.88 months(1~122 months)at first visit,and 36 of them suffered from bilateral RB and 82 from single.Among them,41 received chemotherapy,57 chemotherapy combined with TTT,10 chemotherapy combined with freezing,and 10 enucleation only.After treatment,76 eyes(76/154)were salvaged,with a total salvage rate of 49.35%,and of them,47 eyes were treated with chemotherapy combined with TTT,accounting for 61.84%(47/76).Seventy-eight eyes were enucleated,with a total extraction rate of 50.65%(78/154),and among 63 eyes at stage E,53 were enucleated,accounting for 84.13%.During the mean follow-up time of 86.66±5.69 months,22(18.64%)children died,and 96 cases(81.36%)survived.The 5-year cumulative survival rate of single eye was 71.40%,and of bilateral was 80.00%.Conclusion Intravenous chemotherapy combined with TTT is one of the main ways for RB salvage.Enucleation is still the primary treatment for stage E eyes.