目的:我们旨在分析视网膜母细胞瘤(RB)动脉内化疗(IAC)的4年经验,并检查肿瘤反应,环球打捞,死亡率,以及马来西亚IAC的安全概况。
方法:这是一个回顾性研究,介入病例系列。回顾性分析2018年1月至2021年12月在吉隆坡医院接受使用美法仑和托泊替康进行IAC的20例RB患者的22只眼。肿瘤反应,环球打捞,死亡率,根据视网膜母细胞瘤的国际分类对IAC的安全性进行了比较。
结果:IAC患者的平均年龄为21.3个月。观察到的总体全球救助率为63.6%:更具体地说,A组100%,B组和C组的75%,D组66.7%,E组为42.9%。IAC后肿瘤反应差与较少的全球挽救机会显着相关(P=0.045)。IAC后肿瘤反应良好的总体率为77.3%。具体来说,各组肿瘤反应良好率为100%,75%,75%,A组分别为83.3%和71.4%,B,C,D和E,分别。死亡率为5%。并发症(经导管插入)包括脑梗死(2.2%),氧饱和度(2.2%),呕吐(26.1%),眶周水肿(8.8%),上睑下垂(6.5%),发烧,股骨血肿,和眼睑色素沉着过度(各4.4%)。
结论:四年的经验表明,IAC是一种安全有效的RB管理方法。IAC后反应不佳的患者可能具有较低的全球抢救机会。仔细选择患者对于在有限的医疗保健资源中获得最佳结果至关重要。
OBJECTIVE: We aimed to analyze our 4-year experience of intra-arterial chemotherapy (IAC) for retinoblastoma (RB) and to examine the tumor response, globe salvage, mortality, and safety profile of IAC in the Malaysian profile.
METHODS: This was a retrospective, interventional case series. A total of 22 eyes of 20 patients with RB who underwent IAC using melphalan and topotecan from January 2018 to December 2021 in Hospital Kuala Lumpur were retrospectively reviewed. Tumor response, globe salvage, mortality, and safety profile of IAC were compared based on the International Classification of Retinoblastoma.
RESULTS: The mean patient age at IAC was 21.3 months. An overall globe salvage rate of 63.6% was observed: more specifically, 100% for Group A, 75% for Groups B and C, 66.7% for Group D, and 42.9% for Group E. Poor tumor response after IAC was significantly associated with a lesser chance of globe salvage (P = 0.045). The overall rate of good tumor response following IAC was 77.3%. Specifically, rates of good tumor response in each group were 100%, 75%, 75%, 83.3% and 71.4% in group A, B, C, D and E, respectively. The mortality rate was 5%. Complications (per-catheterization) included cerebral infarct (2.2%), oxygen desaturation (2.2%), vomiting (26.1%), periorbital edema (8.8%), ptosis (6.5%), fever, femoral hematoma, and hyperpigmentation over lid (4.4% each).
CONCLUSIONS: Four-year experience showed that IAC is a safe and effective method for RB management. Patients with a poor response after IAC may have a lower chance of globe salvage. Careful patient selection is of utmost importance to achieve the best outcome in a setting of limited health-care resources.