Francis, J.H., Iyer, S., Gobin, Y.P., Brodie, S.E., Abramson, D.H
玻璃体 视网膜 动脉
摘要：目的：旨在比较单独眼科动脉化疗（OAC）与OAC玻璃体内化疗治疗3型视网膜母细胞瘤玻璃体种子云的疗效和毒性。设计：前瞻性队列研究。研究对象：40例视网膜母细胞瘤患者（19例用OAC单独治疗，21例用OAC加玻璃体内和眼周化疗）的40只含有云眼（3级玻璃体种子）。方法：用Kaplan-Meier估计法估计眼存活率，无病生存率和种子消退时间。通过临床发现和视网膜电图评估眼毒性：比较基线和最后一次随访时的30Hz闪烁反应。通过Student t检验比较连续变量，使用Fisher精确检验比较分类变量。主要观察指标：眼部存活时间，无病生存期和种子消退时间。结果：无病变或治疗相关死亡，无患者表现出肿瘤外化或转移性疾病。两组之间的年龄，偏侧化，疾病或疾病状态（初始治疗与既往治疗）无显着差异。与OAC单独治疗眼相比，OAC +玻璃体内化疗（5.7个月）治疗眼种子消退时间明显缩短（14.6个月; P <0.001）。OAC单独组18个月无病生存率Kaplan-Meier评估显示较差：为67.1％（95％可信区间，40.9％-83.6％），OAC加玻璃体内化疗组为94.1％（95％可信区间，65％-99.1％ ）为（P = 0.05）。 OAC单独组36个月Kaplan-Meier眼生存率估计为83.3％（95％可信区间，56.7％-94.3％），OAC +玻璃体内化疗组为100％（P = 0.16）。视网膜电图反应的平均变化差异无统计学意义（P> 0.05），OAC单独组降低11μV，玻璃体内化疗组（P = 0.4）下降22μV。结论：与单独OAC相比，OAC和玻璃体内和眼眶内治疗玻璃体种子云的消退时间更短，并且需要额外的治疗复发较少，需要摘除的较少。 OAC加玻璃体内化疗组对视网膜的毒性似乎并不明显。
PURPOSE:To compare the efficacy and toxicity of treating class 3 retinoblastoma vitreous seeds with ophthalmic artery chemosurgery (OAC) alone versus OAC with intravitreous chemotherapy.DESIGN:Retrospective cohort study.PARTICIPANTS:Forty eyes containing clouds (class 3 vitreous seeds) of 40 retinoblastoma patients (19 treated with OAC alone and 21 treated with OAC plus intravitreous and periocular chemotherapy).METHODS:Ocular survival, disease-free survival and time to regression of seeds were estimated with Kaplan-Meier estimates. Ocular toxicity was evaluated by clinical findings and electroretinography: 30-Hz flicker responses were compared at baseline and last follow-up visit. Continuous variables were compared with Student t test, and categorical variables were compared with the Fisher exact test.MAIN OUTCOME MEASURES:Ocular survival, disease-free survival, and time to regression of seeds.RESULTS:There were no disease- or treatment-related deaths and no patient demonstrated externalization of tumor or metastatic disease. There was no significant difference in the age, laterality, disease, or disease status (treatment na ve vs. previously treated) between the 2 groups. The time to regression of seeds was significantly shorter for eyes treated with OAC plus intravitreous chemotherapy (5.7 months) compared with eyes treated with OAC alone (14.6 months; P < 0.001). The 18-month Kaplan-Meier estimates of disease-free survival were significantly worse for the OAC alone group: 67.1% (95% confidence interval, 40.9%-83.6%) versus 94.1% (95% confidence interval, 65%-99.1%) for the OAC plus intravitreous chemotherapy group (P = 0.05). The 36-month Kaplan-Meier estimates of ocular survival were 83.3% (95% confidence interval, 56.7%-94.3%) for the OAC alone group and 100% for the OAC plus intravitreous chemotherapy group (P = 0.16). The mean change in electroretinography responses was not significantly different between groups, decreasing by 11 μV for the OAC alone group and 22 μV for the OAC plus intravitreous chemotherapy group (P = 0.4).CONCLUSIONS:Treating vitreous seed clouds with OAC and intravitreous and periocular chemotherapy, compared with OAC alone, resulted in a shorter time to regression and was associated with fewer recurrences requiring additional treatment and fewer enucleations. The toxicity to the retina does not seem to be significantly worse in the OAC plus intravitreous chemotherapy group.