Background Retinoblastoma (RB) is the most common primary ocular malignancy in children.Many treatment modalities have been applied to RB.As an exciting option to reduce systemic adverse effects and increase the local drug concentration,intra-arterial chemotherapy (IAC) was introduced as an important treatment modality for advanced intraocular RB in recent years.Objective The aim of the study was to review the reported efficiency and safety of IAC in the treatment of RB.Methods Based on the established search strategy,we searched the electronic databases of PubMed,Medline,Embase,EBSCO,Web of Science,Wan Fang database,China National Knowledge Infrastructure,China Science and Technology Journal Database and China Biology Medicine disc.All the databases were retrieved from inception until April 2016.Study selection,data extraction,quality assessment and data analysis were performed according to preferred reporting items for systematic reviews and Meta-analyses (PRISMA) statement.Results We included 27 studies reporting more than 1 067 RB patients (1 314 eyes) and over 3 818 IAC treatments.The overall salvage rate achieved 70.3％ for all eyes,76.2％ for first-line IAC,57.5％ for more advanced RB and 76.4％ for patients who did not receive other treatments during or after IAC.Metastases were reported in 23 patients and deaths were reported for 21 patients.Minor systemic complications (such as nausea or vomiting,neutropenia) and local complications (such as retinal pigment epithelium change,conjunctival chemosis and retinal detachment) were frequently reported,but there were few serious systemic complications.Conclusions IAC is a promising salvage therapy for RB without serious systemic complications.However studies with prospective design and long-term follow-up are still needed to identify the proper indication of IAC.%背景 视网膜母细胞瘤(RB)是儿童最常见的眼内恶性肿瘤.目前临床上已有多种方法治疗RB.近些年发展起来的眼动脉内化疗(IAC),在增加视网膜局部药物浓度的同时又可降低全身不良反应,成为近年来眼内进展期RB的一种重要治疗手段. 目的 系统评价IAC在用于RB治疗时的疗效及安全性.方法 按照检索策略,计算机检索PubMed、Medline、Embase、EBSCO、Web of Science、万方数据库、中国知网(CNKI)、维普网(VIP)及中国生物医学文献数据库(CBM),检索时限为建库起至2016年4月.文章筛选、数据提取、质量评级及数据分析参照系统综述和荟萃分析优先报告条目的PRISMA声明进行. 结果 共纳入27个研究,报道了超过1 067例RB患者1 314眼,超过3 818次治疗.总体保眼率为70.3％,一线治疗保眼率为76.2％,进展期RB的保眼率为57.5％,在IAC治疗期间及治疗后未接受其他治疗的患者的保眼率为76.4％.共报道23例转移,21例死亡.恶心呕吐、中性粒细胞减少等轻度全身不良反应和视网膜色素上皮改变、结膜充血、视网膜脱离等局部不良反应较为常见,但严重不良反应鲜有报道. 结论 IAC作为RB的一种治疗手段具有广阔的应用前景,严重不良反应少见,但仍需随访时间长、前瞻性的研究来明确其用于RB治疗的适应证.
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