重视对种植瘤的研究,迎接视网膜母细胞瘤治疗的新变革

摘要

Retinoblastoma (RB) therapy has evolved over decades.In the 1970s, enucleation was important for improving life prognosis.In the 1980s, external beam radiotherapy (EBRT) was popular.In the 1990s, systemic intravenous chemotherapy (IVC) was introduced and currently remains prevalent worldwide for intraocular RB control as well as prevention of systemic metastasis.However, RB seeds in vitreous and subretinal space are still the major obstacles for successful treatments.Advanced ophthalmic imaging technology promotes thorough and detailed description and observation of RB seeds.In the 2000s, interests in periocular chemotherapy (POC), intra-arterial chemotherapy (IAC) and intravitreous chemotherapy (IVitC) have been explored to overcome the low drug concentration around the seeds and to reduce the systemic side effects.This leads us into a new era of target local chemotherapy of RB.How to make the treatment decision based on biological behavior of RB seeds is a major task for us now.%视网膜母细胞瘤(RB)的治疗经历了眼球摘除、外放射治疗和以全身化学治疗为主的综合治疗这3个主要阶段,但玻璃体和视网膜下腔的种植瘤一直是RB治疗的挑战和难点,也是传统治疗方法失败的主要原因.随着眼部影像检查技术的进步,研究者对种植瘤生物学行为的观察更为详细,对种植瘤的认识更为深入.临床研究证实,治疗药物不易到达种植瘤内,从而导致瘤细胞的进一步生长.针对种植瘤的特性,近年来研究出定向局部化学治疗方案,包括球周化学疗法、选择性眼动脉灌注化学疗法、玻璃体腔药物注射等,结果令人鼓舞,提示RB的治疗将迎来新一轮的变革.但如何通过对种植瘤生物学特性的分析来选择化学治疗药物、如何合理地制定治疗方案等问题逐渐成为治疗的新问题,还有很多工作要做.