網膜芽細胞腫に対する新しい化学療法（chemoreduction）の治療成績

Outcome of chemoreduction, a new chemotherapy, for retinoblastoma

（290）　眼内網膜芽細胞腫8例12眼に対して化学療法（chemoreduction）を行った。両眼発症が7例，片眼発症が1例で，3例では片側の眼球摘出術がすでに行われていた。化学療法の開始時の年齢は2か月から2歳11か月で，Shieldsらの6コース法に準じ，vincristine,etoposide,carboplatinを投与した。眼底はReese-Ellsworth分類で評価し，治療開始時ではⅠとⅡが7眼，ⅢとⅣが2眼，Ⅴが2眼であり，硝子体出血のための評価不能1眼であった。効果判定は腫瘍の大きさとregression patternで行った。全例で腫瘍が縮小したが，多くは追加治療を必要とした。最終的に完全寛解が6眼で得られ，放射線外照射追力口が2眼，眼球摘出が3眼に行われた。Reese-Ellsworth分類Ⅴでは効果が弱く限界があったが，今回のchemoreductionは従来からの眼球保存療法の主体である放射線外照射に代わる有効な選択肢になると結論される。

We treated retinoblastoma in 12 eyes of 8 patients with chemoreduction. The series comprised 7 bilateral and 1 unilateral cases. Enucleation had already performed in one eye in 3 bilateral cases. The ages ranged from 2 months to 2 years 11 months at the start of chemoreduction. The patients received a six-cycle regimen of vincristine, etoposide and carboplatin as proposed by Shields et al. When categorized after the Reese-Ellsworth classification sys-tem, there were 7 eyes of group Ⅰ and Ⅱ, 2 eyes of group Ⅲ and Ⅳ, and 2 eyes of group Ⅴ. One eye could not be graded due to vitreous hemorrhage. The efficacy of treatment was evaluated on the basis of tumor size and regression pat-terns. The tumor shrank in all the eyes after treatment, but additional therapy was necessary in the majority of cases. The tumor underwent complete remission in 6 eyes. External beam radiotherapy had to be performed on 2 eyes and enucleation on 3 eyes. Although the effect was limited for group V retinoblastoma, above findings show that chemore-duction is an effective treatment for intraocular retinoblastoma as an alternative to other therapeutic modalities includ-ing external beam radiotherapy.