| Part I Clinical study on the efficacy and safety of intra-arterial chemotherapy for retinoblastomaObjective To compared the efficacy and safety of primary intraophthalmic artery chemotherapy(IAC)and intra-venous chemotherapy(IVC)for patients with advanced retinoblastoma(RB)and to determine the factors associated with complication of IAC treatment.Methods Patients with RB enrolled between September 2014 and September 2016 in our hospital received the primary therapy of IAC and IVC.Eye salvage rate?the tumor recurrence rate,the survival rate and complications in the two groups were assessed.The gender,age,type of drug administered,tumor staging,the orbital angiography and laterality performed were recorded.Univariate and multivariate analyses were performed to determine the factors related to complication of IAC treatment.Results Overall eye salvage rate was 83.3% in IAC group and 59.1% in IVC group.The difference of the overall eye salvage rate between group IAC and group IV-IA were statistically significant.Recurrence rate was 8.3% in IAC group and 13.6% in IVC group.The difference of the recurrence rate between the two groups were not statistically significant.1 patient was dead due to metastasis in IAC group and IVC group without death.Complications of IAC were orbital edema(41.6%),ptosis(20.1%),strabismus(4.2%),vitreous hemorrhage(4.2%),enophthalmos(45.8%)and cataract(8.3%).Complications of IVC were enophthalmos(5.3%)and cataract(10.5%).The difference of the enophthalmos rate between the two groups were statistically significant.Univariate analysis and multivariate analysis showed that type of drug administered(P <.001)were significantly related to the enophthalmos rate of IAC treatment.Conclusions IAC and IVC treatment of RB have their own advantages and limitations.How to reduce or even avoid the complications of IAC treatment requires further basic and clinical studies.Part II Study of pharmacokinetics and injury to eye tissue of intra-arterial chemotherapy carboplatin and lobaplatin in porcineObjective This section intends to inject lobaplatin and carboplatin into the pigs via the ophthalmic artery,studying its pharmacokinetics and the degree of damage to the pig's eye tissue,and further clarifying the application value of lobaplatin in the treatment of retinoblastoma(RB).Methods Ten Tibetan minipigs were divided into two groups: A(carboplatin)group and B(lobetoplatin)group equally.Carboplatin 30 mg or Lobaplatin 3 mg was diluted with 30 ml of 5% glucose injection.After the drug infusion,2ml of blood was taken at the time of 0.5 hour,1 hour,2 hours,2.5 hours,3 hours,3.5 hours,and 4 hours after operation,placed in EDTA-anticoagulant purple tube,and centrifuged.After the blood samples were taken,the experimental pigs were sacrificed and the bilateral eyeballs and optic nerve tissues were taken.After 10% neutral formaldehyde buffer was fixed,pathological HE staining was performed to observe the morphological changes of retinal cells and optic nerve cells.Results One pig died in each group A and B,and the remaining 8 pigs completed the whole experiment.The blood drug concentrations in the carboplatin group and lobaplatin group rapidly decreased with time,and the blood concentration decreased gradually from 3 hours to 4 hours after administration.The initial phase of the drug concentration curve in the lobaplatin group was “steeper” than the carboplatin group.In the carboplatin group and lobaplatin group,the retinal cell morphology was normal in both groups after ophthalmic artery instillation,and there was no cell lysis or nuclear pyknosis.The morphology of retinal arteriole endothelial cells was normal.There were no abnormalities in the morphology of the optic nerve cells in both groups.Conclusions The concentration of blood drug in the two groups decreased rapidly with time,and the blood concentration decreased gradually.There was no damage to the eye tissue and optic nerve.However,there are still deficiencies in this study,so it is still necessary to further research. |
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