體外放射線對未經手術的視網膜母細胞瘤之治療效果: 回溯性研究報告

　　　　　目的:本篇回溯性研究報告乃針對未經手術之9位共13個眼睛的視網膜母細胞瘤病 人，接受體外放射線治療之效果。 材料與方法:自1988年五月至1997年二月，一共有9位共13個眼睛的視網膜母細胞瘤病人， 於本院接受體外放射線治療。其中包括了6名男孩和3位女孩。雙側病灶的有4位病人,單側 病灶的有5位病人。平均診斷的年紀為25.8個月(中位數:24.3個月)。放射治療是以百萬伏 特體外照射(Mega-voltage external beam radiation)，光子能量自6至15百萬伏特(MV)。 放射線劑量為30 Gy至60 Gy(平均值:47.1 Gy;中位數:51.0 Gy)，每天照射一次，每次1.8 至2.0 Gy。疾病的分期是採用St. Jude Children's Research Hospital所提出的分期法。 其中有8位病患因治療前已有局部眼球外侵犯或遠端轉移，而輔以化學治療。 結果:追□7.1至115.5個月後(中位數:20.5個月)，13個眼睛有3個病灶局部治療失敗 (3/13;23.1%)。遠端轉移有5位病人(5/9;55.6%)，3年總存活率為56.3%(5/9)，3年無病存 活率(disease-free survival rate)為25.9%(3/9)。有5個眼睛(4位病人)維持視力(於一公 尺處可見手部搖動)。更有4個眼睛(3位病人)維持至少能辨識手指的視力。 結論:早期診斷和治療仍是獲得高治癒率最有效的辦法，即使是局部嚴重之視網膜母細胞瘤, 我們建議仍以體外放射線作為第一線的治療，是否合併化學治療端視腫瘤侵犯的程度及是否 有遠端轉移。而眼球剜除術(enucleation)則留待為局部腫瘤復發之援救性治療。然而對後遺 症的評估則需更長期的追□。
　　　　　Purpose: To determinate the effects of external beam radiation alone for patients with retinoblastoma. Materials and Methods: Between May 1988 to February. 1997, 9 patients (13 eyes) with non-operative retinoblastoma (St. Jude Children's Research Hospital classification) received external beam radiotherapy alone. The mean age at diagnosis was 25.8 months with 6 males and 3 females. Four of 9 patients had bilateral retinoblastoma. Radiation doses ranged from 30 Gy-60 Gy (mean 47.1 Gy, median 51.0 Gy) in 1.8-2.0 Gy fractions by using electron or photon beam. Eight patients had been received chemotherapy. Results: At median follow up of 20.5 months (range 7.1-115.5 months), the local failure rate, 3-year disease-free survival rate and 3-year overall survival rate of 23.1%, 25.9%, and 56.3% were obtained. Conclusion: We concluded that external beam radiotherapy alone is an efficient treatment in local control for local advanced non-operative retinoblastoma. In our series, the tumor was locally controlled in 10 eyes (7 patients). Distant metastasis was the major failure in these patients. Primary radiotherapy was used to maintain normal vision, salvage treatment by enucleation is suggested. But longer follow-up time is needed.