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目的探讨脑脊液中找肿瘤细胞对判断视网膜母细胞瘤(RB)转移及预后的价值。方法选取本院2006年11月-2008年7月临床确诊为RB的患儿256例。男154例,女102例;单眼患儿171例,双眼患儿85例。治疗前常规行腰椎穿刺,并在脑脊液中找肿瘤细胞,观察有无肿瘤细胞及其与预后的关系。对脑脊液中发现肿瘤细胞的患儿予6~9个周期的化疗和8~10次鞘内注射,化疗方案采用CTV(卡铂、替尼泊苷和长春新碱)方案,鞘内注射药物为阿糖胞苷、甲氨蝶呤和地塞米松。随访时间8~23个月,平均14.6个月。结果256例患儿中8例脑脊液中发现肿瘤细胞,其中1例脑膜弥散浸润性转移,死亡;1例发生颅内转移,进一步行大剂量化疗+自体外周血造血干细胞移植,目前病情稳定;余6例随访期间行眼球摘除,病理证实4例侵犯视神经,占67%(4/6例),其中2例累及视神经断端;6例均未发现其他转移证据。结论RB常见的途径是沿视神经向颅内转移;脑脊液检查找肿瘤细胞对于早期判断颅内转移、早期治疗及预后有重要意义。
Objective To investigate the value of finding tumor cells in cerebrospinal fluid (CSF) to evaluate the metastasis and prognosis of retinoblastoma (RB). Methods Totally 256 children with RB diagnosed in our hospital from November 2006 to July 2008 were selected. There were 154 males and 102 females; 171 eyes were monocular and 85 eyes were children. Lumbar puncture was routinely performed before treatment, and tumor cells were observed in cerebrospinal fluid to observe the presence or absence of tumor cells and their relationship with prognosis. Six to nine cycles of chemotherapy and eight to ten intrathecal injections of tumor cells were found in cerebrospinal fluid. The chemotherapy regimen consisted of CTV (carboplatin, teniposide and vincristine) regimens and intrathecal injections of Cytarabine, methotrexate and dexamethasone. Follow-up time was 8 to 23 months, an average of 14.6 months. Results Tumor cells were found in 8 of 256 children with cerebrospinal fluid. Among them, 1 patient had diffuse infiltration and death of the meninges, 1 patient had intracranial metastasis, and further received high-dose chemotherapy and autologous peripheral blood stem cell transplantation. At present, the disease remained stable. 6 cases were followed up by enucleation. The pathology confirmed 4 cases of optic nerve invasion, accounting for 67% (4/6 cases), of which 2 cases involved the optic nerve ends; 6 cases showed no evidence of other metastases. Conclusion RB is a common way to intracranial metastasis along the optic nerve; cerebrospinal fluid to find tumor cells for the early diagnosis of intracranial metastases, early treatment and prognosis of great significance.