{"title":"视网膜母细胞瘤化疗模式的最新进展:进步与挑战","authors":"Thanaporn Kritfuangfoo , Duangnate Rojanaporn","doi":"10.1016/j.apjo.2024.100061","DOIUrl":null,"url":null,"abstract":"<div><p>Retinoblastoma stands as a paradigm of success in treating malignancies among pediatric patients. Over recent decades, the approach to managing retinoblastoma has evolved significantly, transitioning from the preservation of patients' lives to the preservation of eyes and vision while minimizing treatment-related complications. Chemotherapy, administered through diverse routes, has solidified its role as the cornerstone of retinoblastoma treatment. In addition to intravenous chemotherapy (IVC), alternative administration routes, including intraarterial (IAC), intravitreal, intracameral, and periocular delivery, have emerged as promising modalities for retinoblastoma management. Numerous studies have demonstrated outstanding outcomes, achieving nearly 100% salvage rates for eyes classified under groups A–C. However, for advanced intraocular retinoblastoma (groups D and E eyes), IAC appears to offer superior local control rates compared to IVC. Intravitreal injection of chemotherapeutic agents, when administered in a controlled and secure manner, holds promise in averting the need for enucleation and radiotherapy in advanced retinoblastoma cases presenting with vitreous seeds. The optimal chemotherapy strategy remains meticulously tailored based on numerous factors. This review provides a comprehensive update on chemotherapy across various routes, encompassing key considerations, dosages, administration methods, treatment outcomes, and potential complications. 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引用次数: 0
摘要
视网膜母细胞瘤是治疗儿童恶性肿瘤的成功典范。近几十年来,治疗视网膜母细胞瘤的方法发生了显著变化,从保护患者生命过渡到保护眼睛和视力,同时最大限度地减少治疗相关并发症。通过不同途径进行的化疗已巩固了其作为视网膜母细胞瘤治疗基石的地位。除静脉化疗(IVC)外,其他给药途径,包括动脉内给药(IAC)、玻璃体内给药、巩膜内给药和眼周给药等,都已成为视网膜母细胞瘤治疗的有效方法。大量研究表明,A-C 组的治疗效果显著,挽救率接近 100%。然而,对于晚期眼内视网膜母细胞瘤(D 组和 E 组眼睛),IAC 的局部控制率似乎优于 IVC。在控制和安全的情况下进行玻璃体内注射化疗药物,有望避免对伴有玻璃体种子的晚期视网膜母细胞瘤病例进行去核手术和放射治疗。最佳化疗策略仍需根据众多因素精心定制。本综述全面介绍了各种途径化疗的最新情况,包括主要考虑因素、剂量、给药方法、治疗效果和潜在并发症。此外,它还探讨了新出现的潜在治疗方法,并概述了旨在提高治疗效果的未来方向。
Update on chemotherapy modalities for retinoblastoma: Progress and challenges
Retinoblastoma stands as a paradigm of success in treating malignancies among pediatric patients. Over recent decades, the approach to managing retinoblastoma has evolved significantly, transitioning from the preservation of patients' lives to the preservation of eyes and vision while minimizing treatment-related complications. Chemotherapy, administered through diverse routes, has solidified its role as the cornerstone of retinoblastoma treatment. In addition to intravenous chemotherapy (IVC), alternative administration routes, including intraarterial (IAC), intravitreal, intracameral, and periocular delivery, have emerged as promising modalities for retinoblastoma management. Numerous studies have demonstrated outstanding outcomes, achieving nearly 100% salvage rates for eyes classified under groups A–C. However, for advanced intraocular retinoblastoma (groups D and E eyes), IAC appears to offer superior local control rates compared to IVC. Intravitreal injection of chemotherapeutic agents, when administered in a controlled and secure manner, holds promise in averting the need for enucleation and radiotherapy in advanced retinoblastoma cases presenting with vitreous seeds. The optimal chemotherapy strategy remains meticulously tailored based on numerous factors. This review provides a comprehensive update on chemotherapy across various routes, encompassing key considerations, dosages, administration methods, treatment outcomes, and potential complications. Furthermore, it explores emerging potential treatments and outlines future directions aimed at enhancing treatment outcomes.
期刊介绍:
The Asia-Pacific Journal of Ophthalmology, a bimonthly, peer-reviewed online scientific publication, is an official publication of the Asia-Pacific Academy of Ophthalmology (APAO), a supranational organization which is committed to research, training, learning, publication and knowledge and skill transfers in ophthalmology and visual sciences. The Asia-Pacific Journal of Ophthalmology welcomes review articles on currently hot topics, original, previously unpublished manuscripts describing clinical investigations, clinical observations and clinically relevant laboratory investigations, as well as .perspectives containing personal viewpoints on topics with broad interests. Editorials are published by invitation only. Case reports are generally not considered. The Asia-Pacific Journal of Ophthalmology covers 16 subspecialties and is freely circulated among individual members of the APAO’s member societies, which amounts to a potential readership of over 50,000.