| Background and Objective:Retinoblastoma is the most common intraocular malignancy in children. Intraocular advanced retinoblastoma may metastasize to brain leading to death. The treatment of intraocular advanced retinoblastoma is still the greatest challenge and attract great attention. At present systemic chemotherapy and local radiotherapy are difficult to achieve satisfactory therapeutic effect. Ophthalmic artery chemotherapy was to increasing local concentration and decreasing the systemic distribution of the chemotherapeutic drug, consequently improving chemotherapy efficiency and minimizing drug-related toxicities, which showed great advantages than other methods. However, the standardized treatment and long-term efficacy still need to be explored. In this article, we explored the relationship between ophthalmic artery chemotherapy and clinical outcome.Methods:Consecutive patients who underwent ophthalmic artery chemotherapy for intraocular advanced retinoblastoma from November 2009 to March 2015 in our center were retrospectively analyzed in this study. Data were collected, including age, sex,IIRC grade, previous treatment. And then the patients received ophthalmic artery chemotherapy. The route, frequency, drug and releated complications were recorded All the patients were followed up and the clinical outcome was evaluated. Analysis using SPSS 13 statistical analysis system. Two groups of independent measurement samples were compared using independent samples t test, the count data between the two groups were compared using chi square test, test the level of α=0.05, when the P<0.05 difference was statistically significant.Results: A total of 93 patients were enrolled in this study. There were 50 boys(53.8%)and 43 girls(46.2%); the boys’ average age was 26.1 months and the girls’ with an average age of 23.3 months, all patients with an average age of 24.8 months. In 93 cases with 112 eyes, 91 eyes achieved globe salvage and 21 eyes received enucleation,globe salvage rate was 81.2%. 74 eyes of IIRC D grade were successfully treatment,globe salvage rate was 96.1%;17 eyes of IIRC E grade achieved globe salvage, globe salvage rate was 96.1%; the difference between the two groups was statistically significant. The globe salvage rates was 70.4% in these 27 eyes which received previous treatment; The globe salvage rates was 84.7% in these 72 eyes without the previous treatment; The globe salvage rate was 74.2% in these eyes which accept just one ophthalmic artery chemotherapy; The globe salvage rate was 83.1% in these eyes which accept two ophthalmic artery chemotherapy; The globe salvage rate was 87.5%in these eyes which accept three ophthalmic artery chemotherapy; There are 83 eyes receiver internal carotid artery to ophthalmic artery chemotherapy and the globe salvage rate was 86.7; The globe salvage rate was 68.2% in eyes received internal carotid artery to ophthalmic artery combined middle meningeal artery to ophthalmic artery routes; In eyes just received middle meningeal artery to ophthalmic artery chemotherapy, the globe salvage rate was57.1%. Globe salvage rate was 81.6% in 87 eyes received melphalan chemotherapy; Globe salvage rate was 80.0% in 25 eyes received melphalan combined carboplatin chemotherapy; In this group, 2 eyes occurred ophthalmic artery spasm; 39 eyes appeared swollen eyelids, 24 eyes appeared ptosis, 1 eye presist exotropia, 1 eye appeared ocular dysmotility, 9 patients occurred leukopenia.Conclusion:Ophthalmic artery chemotherapy is safe and effective for the treatment of intraocular advanced retinoblastoma. International intraocular retinoblastoma classification can be used for the assessment of prognosis. The route of ophthalmic artery chemotherapy can have an impact on the clinical outcome, and the internal carotid artery-ophthalmic artery route can achieve the highest globe salvage rates. The standardization of ophthalmic artery chemotherapy still need further exploration. |
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