メルファランの選択的眼動脈注入による網膜芽細胞腫の眼球保存療法

Conservative treatment of retinoblastoma with selective injection of melphalan into the ophthalmic artery

要約　目的：メルファランの眼動脈注入による網膜芽細胞腫の治療報告。対象：過去18か月間に網膜芽細胞腫で眼球保存療法の適応があると判断した7例10眼を対象とした。男児2例，女児5例であり，4例が片眼性，3例が両眼性であった。年齢は1か月～1年8か月（中央値1年4か月）であった。Reese-Ellsworth分類による病期は，Ⅰbが3眼，Ⅱaが4眼，Ⅲbが1眼，Ⅴbが2眼であった。方法：初回治療としてVECによる全身化学療法を2コース行い，以後は眼底所見に応じて，メルファランの眼動脈と硝子体注入，経瞳孔的温熱療法，ルテニウムの強膜縫着，眼球摘出を行った。結果：10か月間に31回の選択的眼動脈注入を10眼すべてに行った。転帰は治癒5眼，治癒見込1眼，治療中2眼，眼球摘出2眼であり，合併症はなかった。結論：メルファランの眼動脈注入による網膜芽細胞腫の治療は，全身への影響が少なく，入院期間が短縮され，安全で有効な眼球保存療法である。

Abstract.　Purpose：To report treatment of retinoblastoma with selective injection of melphalan into the ophthalmic artery. Cases：This study was made on 10 eyes of 7 cases of retinoblastoma who received conservative treatment during the past 18 months. The series comprised 2 males and 5 females. Retinoblastoma was unilateral in 4 cases and bilateral in 3. The age ranged from one to 20 months, median 16 months. Stage of retinoblastoma was Ⅰb 3 eyes, Ⅱa 4 eyes, Ⅲb one eye, and Ⅴb 2 eyes. Method：All the cases received, initially, 2 courses of VEC（vincristine, etoposide and carboplatine）. Following treatments were performed depending on the fundus findings：injection of melphalan into the ophthalmic artery and vitreous, transpupillary thermotherapy, brachytherapy with ruthenium, or enuculeation. Results：Injection of melphalan was performed in 10 eyes in 31 sessions during a 10-month period. Cure was obtained in 5 eyes, was expected in one eye, 2 eyes were still under treatment, and enucleation was performed on 2 eyes. Complication was absent throughout. Conclusion：Selective injection of melphalan into the ophthalmic artery is safe and effective for retinoblastoma with minimum systemic side effects and short hospitalization.