Purpose To evaluate retinoblastoma control following chemoreduction. Design In terventional case series. Methods Prospective. Setting Single center trial. Pati ent population 457 retinoblastomas in 193 eyes of 125 pat...Purpose To evaluate retinoblastoma control following chemoreduction. Design In terventional case series. Methods Prospective. Setting Single center trial. Pati ent population 457 retinoblastomas in 193 eyes of 125 patients. Nonrandomized, n oncomparative study. Intervention All patients received intravenous vincristine, etoposide, and carboplatin,. The tumors were managed with chemoreduction alone (group W) or chemoreduction combined with thermotherapy (group X), cryotherapy ( group Y), or both thermotherapy and cryotherapy (group Z). Main outcome measure Tumor recurrence in each treatment group. Results Of 457 retinoblastomas, 63 (14 %) were in groupW, 256 (56%) in group X, 127 (28%) in group Y, and 11 (2%) i n group Z. The tumor was located in the macula in 33 (52%) of group W, 109 (43 %) of group X, 3 (2%) of group Y, and 9 (1%) of group Z. The mean tumor thick ness at initial examination was 7 mm for group W, 4 mm for group X, 2 mm for gro up Y, and 3 mm for group Z. Using Kaplan-Meier estimates, recurrence of the ind ividual retinoblastoma at 7 years was found in 45%of groupWand 18%for combined groups X, Y, and Z. Risk factors predictive of tumor recurrence by multivariate analysis included macular tumor location for all groups and additionally female gender for group W and increasing tumor thickness for groups X, Y, and Z. Concl usions Chemoreduction alone or combined with cryotherapy or thermotherapy is eff ective for treatment of retinoblastoma, but tumor recurrence rate is highest for those located in the macula and those with greater thickness.展开更多
Objective: To evaluate the effectiveness of chemoreduction alone and chemoredu ction with thermotherapy for macular retinoblastoma. Design: Prospective, nonran domized, single-center case series. Setting: Ocular Oncol...Objective: To evaluate the effectiveness of chemoreduction alone and chemoredu ction with thermotherapy for macular retinoblastoma. Design: Prospective, nonran domized, single-center case series. Setting: Ocular Oncology Service at Wills E ye Hospital of Thomas Jefferson University in conjunction with the Division of O ncology at the Children’s Hospital of Philadelphia (Pa). Participants: There we re 68 macular retinoblastomas in 62 eyes of 49 patients managed with chemoreduct ion from January 1995 through January 2003. Intervention: All patients received 6 cycles of intravenous chemoreduction using vincristine, etoposide, and carbopl atin. The patients were then treated according to 1 of 2 approaches: chemoreduct ion alone with no adjuvant focal therapy (group A) or chemoreduction combined wi th adjuvant foveal-sparing thermotherapy to each macular retinoblastoma (group B).Main Outcome Measure: Tumor recurrence. Results: Of the 68 tumors, 28 were in group A and 40 were in group B. A comparison of both groups revealed that the t umors were similar with regard to clinical features. The mean tumor basal dimens ion was 12.3 mm for group A and 12.1 mm for group B, and the mean tumor thicknes s was 6.8 mm for group A and 6.1 mm for group B. Tumors in group A occupied a me an of 71%of the macula, and those in group B occupied 74%of the macula. Follow ing treatment, Kaplan-Meier estimates revealed that group A tumors showed recur rence in 25%by 1 year and 35%by 4 years whereas those in group B showed recurr ence in 17%by 1 year and 17%by 4 years. All recurrences were treated with addi tional focal thermotherapy, cryotherapy, or plaque radiotherapy except for 1 tha t required external beam radiotherapy and 1 that required enucleation, both in g roup A. Univariate analysis revealed that predictors of tumor recurrence were in traretinal growth pattern (vs endophytic); small tumor basal dimension (less tha n 3 mm and occupying a smaller percentage of the macula); absence of subretinal fluid, subretinal seeds, and vitreous seeds; and chemoreduction response with le ss tumor calcification and tumor regression of type 0 (complete disappearance wi thout a scar). By multivariate analysis, the most important factors predictive o f tumor recurrence were smallermacular tumor size (judged by percentage of thema cula occupied by the tumor), absence of subretinal or vitreous seeds, and unilat eral disease. Conclusions: Treatment of macular retino- blastomawith chemoreduction plus adjuvant foveal-sparing thermotherapy provid es tumor control of 83%by 4 years, and this is slightly more favorable than che moreduction alone, which provides control of 65%by 4 years. Tumors most destine d for recurrence are small tumors.展开更多
文摘Purpose To evaluate retinoblastoma control following chemoreduction. Design In terventional case series. Methods Prospective. Setting Single center trial. Pati ent population 457 retinoblastomas in 193 eyes of 125 patients. Nonrandomized, n oncomparative study. Intervention All patients received intravenous vincristine, etoposide, and carboplatin,. The tumors were managed with chemoreduction alone (group W) or chemoreduction combined with thermotherapy (group X), cryotherapy ( group Y), or both thermotherapy and cryotherapy (group Z). Main outcome measure Tumor recurrence in each treatment group. Results Of 457 retinoblastomas, 63 (14 %) were in groupW, 256 (56%) in group X, 127 (28%) in group Y, and 11 (2%) i n group Z. The tumor was located in the macula in 33 (52%) of group W, 109 (43 %) of group X, 3 (2%) of group Y, and 9 (1%) of group Z. The mean tumor thick ness at initial examination was 7 mm for group W, 4 mm for group X, 2 mm for gro up Y, and 3 mm for group Z. Using Kaplan-Meier estimates, recurrence of the ind ividual retinoblastoma at 7 years was found in 45%of groupWand 18%for combined groups X, Y, and Z. Risk factors predictive of tumor recurrence by multivariate analysis included macular tumor location for all groups and additionally female gender for group W and increasing tumor thickness for groups X, Y, and Z. Concl usions Chemoreduction alone or combined with cryotherapy or thermotherapy is eff ective for treatment of retinoblastoma, but tumor recurrence rate is highest for those located in the macula and those with greater thickness.
文摘Objective: To evaluate the effectiveness of chemoreduction alone and chemoredu ction with thermotherapy for macular retinoblastoma. Design: Prospective, nonran domized, single-center case series. Setting: Ocular Oncology Service at Wills E ye Hospital of Thomas Jefferson University in conjunction with the Division of O ncology at the Children’s Hospital of Philadelphia (Pa). Participants: There we re 68 macular retinoblastomas in 62 eyes of 49 patients managed with chemoreduct ion from January 1995 through January 2003. Intervention: All patients received 6 cycles of intravenous chemoreduction using vincristine, etoposide, and carbopl atin. The patients were then treated according to 1 of 2 approaches: chemoreduct ion alone with no adjuvant focal therapy (group A) or chemoreduction combined wi th adjuvant foveal-sparing thermotherapy to each macular retinoblastoma (group B).Main Outcome Measure: Tumor recurrence. Results: Of the 68 tumors, 28 were in group A and 40 were in group B. A comparison of both groups revealed that the t umors were similar with regard to clinical features. The mean tumor basal dimens ion was 12.3 mm for group A and 12.1 mm for group B, and the mean tumor thicknes s was 6.8 mm for group A and 6.1 mm for group B. Tumors in group A occupied a me an of 71%of the macula, and those in group B occupied 74%of the macula. Follow ing treatment, Kaplan-Meier estimates revealed that group A tumors showed recur rence in 25%by 1 year and 35%by 4 years whereas those in group B showed recurr ence in 17%by 1 year and 17%by 4 years. All recurrences were treated with addi tional focal thermotherapy, cryotherapy, or plaque radiotherapy except for 1 tha t required external beam radiotherapy and 1 that required enucleation, both in g roup A. Univariate analysis revealed that predictors of tumor recurrence were in traretinal growth pattern (vs endophytic); small tumor basal dimension (less tha n 3 mm and occupying a smaller percentage of the macula); absence of subretinal fluid, subretinal seeds, and vitreous seeds; and chemoreduction response with le ss tumor calcification and tumor regression of type 0 (complete disappearance wi thout a scar). By multivariate analysis, the most important factors predictive o f tumor recurrence were smallermacular tumor size (judged by percentage of thema cula occupied by the tumor), absence of subretinal or vitreous seeds, and unilat eral disease. Conclusions: Treatment of macular retino- blastomawith chemoreduction plus adjuvant foveal-sparing thermotherapy provid es tumor control of 83%by 4 years, and this is slightly more favorable than che moreduction alone, which provides control of 65%by 4 years. Tumors most destine d for recurrence are small tumors.
