轉移性視網膜胚細胞瘤的新希望


  June 26, 2003 - 根據發表在六月份的Ophthalmology中,針對4例小兒科病人所做的研究報告顯示,轉移性視網膜胚細胞瘤經多模型治療後長期生存是可能的。
  
  田納西州St. Jude兒童研究醫院的Carlos Rodriguez-Galindo, MD表示,我們的結果顯示,視網膜腫瘤如果轉移到身體其他部位,是可以治癒的,因為化療本身僅導致暫時改善,所有的病人最後還是隨著病情惡化死亡,然而化療配合放療和幹細胞治療實際上可以挽救病人的生命,所以我們相信如果疾病早期被診斷出來,在擴散之前,超過90%的病人手術可以治癒。
  
  四例轉移性視網膜胚細胞瘤(已經轉移到骨骼和骨髓)經密集的化療、megatherapy強化,以及自體移植造血幹細胞治療,這些幹細胞經二到四個過程的化療後(carboplatin和etoposide、cyclophosphamide和etoposide、carboplatin或cisplatin交替使用)收穫,而放射治療的目標區域為轉移骨骼。
  
  在研究中,所有病人完成治療過程且對治療有反應,化療兩個療程後所有病人出現骨髓疾病的完全反應,在隨後的追蹤中,兩個病人生存超過六年,另外兩個病人中樞神經系統疾病復發後死亡。
  
  作者正在與多中心專家合作制定一套該治療方案的國家計劃草案,每年美國有300-350個視網膜胚細胞瘤病例,大約15 (5%)是轉移性的,在發展中國家,40%-50%的視網膜胚細胞瘤病人進展為轉移性疾病。
  
  美國眼科學會發言人William Mieler, MD表示,這項研究及其他可比較研究,提供即將到來治療這種惡性災難性疾病的令人鼓舞的證據,一旦計劃草案建立起來並在更多的病人身上試驗,我們希望看到對惡性轉移性視網膜胚細胞瘤的進一步有效治療。
  
  這項研究由國家癌症研究院的U.S. Public Health Service研究經費、American Lebanese Syrian Associated Charities in Memphis、Research to Prevent Blindness, Inc.以及紐約市的St. Giles Foundation等資助。
  

New Hope for Metastatic Retino

By Laurie Barclay, MD
Medscape Medical News

June 26, 2003 — Long-term survival in metastatic retinoblastoma is possible with multimodal therapy, according to a series of four pediatric cases published in the June issue of Ophthalmology.

"Our results show that retinal tumors that metastasize to other areas of the body can be cured," lead author Carlos Rodriguez-Galindo, MD, from St. Jude Children's Research Hospital in Memphis, Tennessee, says in a news release. "Chemotherapy by itself only results in transient improvement, with all patients dying of disease progression eventually, whereas chemotherapy in combination with radiation and stem-cell therapies can actually save patients' lives. We believe more than 90% of patients can be cured with surgery if the disease is detected early enough, before the disease spreads."

Four consecutive patients with retinoblastoma metastatic to the bone and bone marrow were treated with intensive chemotherapy, consolidation with megatherapy, and autologous hematopoietic stem cell rescue with cells harvested after two to four courses of chemotherapy consisting of courses of carboplatin and etoposide alternating with cyclophosphamide, etoposide, and either carboplatin or cisplatin. Radiation therapy targeted areas of bone metastases.

All patients completed and responded to treatment, and all had complete response of the bone marrow disease after two courses of chemotherapy. Two patients survived free of disease longer than six years. The other two patients died after recurrence of disease in the central nervous system.

The authors are collaborating with experts at multiple centers in developing a national protocol to implement this treatment regimen. Of 300 to 350 retinoblastoma cases in the U.S. each year, approximately 15 (5%) are metastatic. In developing countries, 40% to 50% of retinoblastoma patients develop metastatic disease.

"This study, along with comparable studies..., provides encouraging evidence that a successful approach to treating this advanced, devastating disease is close at hand," says American Academy of Ophthalmology spokesperson William Mieler, MD. "Once the protocol is further established and tested on additional patients, we can hope to see further documentation of effective treatment for patients with advanced metastatic retinoblastoma."

This study was supported by U.S. Public Health Service grants from the National Cancer Institute, the American Lebanese Syrian Associated Charities in Memphis, Tennessee, Research to Prevent Blindness, Inc., and the St. Giles Foundation in New York City.

Ophthalmology. 2003;110:1237-1240

Reviewed by Gary D. Vogin, MD

    
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