动脉化疗与静脉-动脉联合化疗治疗眼内晚期视网膜母细胞瘤的有效性与安全性

doi:10.3877/cma.j.issn.2095-5782.2018.02.006

目的：

比较晚期视网膜母细胞瘤（RB）经眼动脉灌注化疗（IAC）与静脉化疗联合眼动脉灌注化疗（IV-IAC）的安全性与有效性。

方法：

选取2012年9月-2016年11月我院收治的眼内晚期(D/E期)初诊RB患者80例。42例进行经眼动脉灌注化疗，为IAC组；38例行2次静脉化疗后联合经眼动脉灌注化疗，为IV-IAC组；比较两组治疗方法的有效性与安全性。

结果：

（1）保眼与复发转移情况：IAC组42人46只眼球，平均随访20.2个月，39只眼成功保留，总体保眼率为84.7%。1例患者转移并死亡，转移率和死亡率为2.2%；IV-IAC组38人44只眼，平均随访21.4个月，34只眼成功保留，总体保眼率为77.3%，1例转移并死亡，转移率和死亡率为2.3%；两组复发率分别为13.0%（6/46）及15.9%（7/44）。两组保眼率、复发率、转移率、死亡率差异均无统计学意义（P>0.05）。（2）并发症：IAC组眼球内陷发生率为41.3%（19/46），4例患眼并发白内障，17只患眼眼睑水肿，12只眼睑下垂，1患眼斜视，1患眼玻璃体出血；IV-IAC组眼球内陷发生率为22.7%（10/44），15例眼睑水肿，12例眼睑下垂。IAC组眼球内陷发生率高于IV-IAC组（P=0.007）。

结论：

两次静脉化疗联合动脉化疗治疗晚期视网膜母细胞瘤对比单纯动脉化疗可能不会降低患者的总体转移率，但会降低患者眼球内陷和白内障的发生率。

关键词: 视网膜母细胞瘤, 经眼动脉灌注化疗, 静脉化疗, 保眼率, 并发症

Objective:

To compare the efficacy and safety of intra-arterial chemotherapy (IAC) and intravenous plus intra-arterial chemotherapy (IV-IAC) for patients with late-stage retinoblastoma.

Methods:

A total of 80 patients diagnosed with retinoblastoma between September 2013 and February 2016 without any treatment history were included. Forty-two patients treated with primary intra-arterial chemotherapy were defined as IAC group. Three-eight patients treated with primary twice intravenous plus intra-arterial chemotherapy were defined as IV-IAC group. Eye salvage rate, enucleation-free survival and mid-to-long term complications were assessed.

Results:

(1) Clinical results: A total of 46 eyes in group IAC were included. During the medium follow-up period of 20.2 months, the overall eye salvage rate was 84.7%, 1 patient was dead due to metastasis (2.2%) , 6 eyes developed recurrence (13.0%) ; Totally 49 eyes in group IV-IAC were included. Over all eye salvage rate was 77.3% with a medium follow-up period of 21.4 months. One patient died due to metastasis (2.3%) , 7 eyes developed recurrence (15.9%) . (2) Complications: Complications in group IAC were enophthalmos (n=19) , cataract (n=4) , vitreous haemorrhage (n=1) , orbital edema (n=17) and ptosis (n=12) . Complications in group IV-IAC were enophthalmos (n=10) , orbital edema (n=15) and ptosis (n=12) . The difference of the overall eye salvage rate, recurrence rate, metastatic rate and death rate between group IAC and group IV-IAC were not statistically significant (P>0.05) , but the enophthalmos rate was higher in group IAC (P=0.006) .

Conclusions:

The primary IV-IAC for retinoblastoma could not effectively lower the eye salvage rate, but it will reduce the incidence of enophthalmos and cataracts.

Key words: Retinoblastoma, Intra-artery chemotherapy, Intravenous chemotherapy, Eye salvage rate, Complication

图1 经眼动脉灌注化疗造影表现

表1 IAC组与IV-IAC组患儿的一般资料比较

组别	例数	发病年龄（月）	体质量(kg)	性别（男/女）	眼别		眼数（只）	分期
组别	例数	发病年龄（月）	体质量(kg)	性别（男/女）	单眼	双眼	眼数（只）	D期	E期
IAC组	42	15.7±1.2	10.6±1.3	28/14	38(90.5)	4(9.5)	46	37(80.4)	9(19.6)
IV-IAC组	38	16.1±0.9	11.2±1.8	24/14	32(84.2)	6(15.8)	44	33(75.0)	11(25.0)
统计量	?	t=0.41	t=0.72	χ²=0.48	χ²=1.54		?	χ²=0.22
P值	?	0.825	0.415	0.582	0.208		?	0.710

表1 IAC组与IV-IAC组患儿的一般资料比较

组别	例数	发病年龄（月）	体质量(kg)	性别（男/女）	眼别		眼数（只）	分期
组别	例数	发病年龄（月）	体质量(kg)	性别（男/女）	单眼	双眼	眼数（只）	D期	E期
IAC组	42	15.7±1.2	10.6±1.3	28/14	38(90.5)	4(9.5)	46	37(80.4)	9(19.6)
IV-IAC组	38	16.1±0.9	11.2±1.8	24/14	32(84.2)	6(15.8)	44	33(75.0)	11(25.0)
统计量	?	t=0.41	t=0.72	χ²=0.48	χ²=1.54		?	χ²=0.22
P值	?	0.825	0.415	0.582	0.208		?	0.710

表2 IAC组与IV-IAC组患儿的并发症发生情况比较　只（%）

组别	眼数（只）	眼球内陷	白内障	玻璃体出血	眼睑水肿	眼睑下垂	斜视
IAC组	46	19(41.3)	4(8.7)	1(2.2)	17(37.0)	12(26.1)	1(2.2)
IV-IAC组	44	10(22.7)	0	0	15(34.1)	12(27.3)	0
χ²值	?	5.75	-	-	0.18	0.35	-
P值	?	0.007	0.117^Δ	1^Δ	0.712	0.612	1^Δ

表2 IAC组与IV-IAC组患儿的并发症发生情况比较　只（%）

组别	眼数（只）	眼球内陷	白内障	玻璃体出血	眼睑水肿	眼睑下垂	斜视
IAC组	46	19(41.3)	4(8.7)	1(2.2)	17(37.0)	12(26.1)	1(2.2)
IV-IAC组	44	10(22.7)	0	0	15(34.1)	12(27.3)	0
χ²值	?	5.75	-	-	0.18	0.35	-
P值	?	0.007	0.117^Δ	1^Δ	0.712	0.612	1^Δ

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Efficacy and safety of primary intra-arterial chemotherapy and intravenous plus intra-arterial chemotherapy for treatment of late-stage retinoblastoma

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Efficacy and safety of primary intra-arterial chemotherapy and intravenous plus intra-arterial chemotherapy for treatment of late-stage retinoblastoma