125I粒子植入放疗在儿童眼眶横纹肌肉瘤综合治疗中的应用

doi:10.3760/cma.j.cn115909-20191205-00324

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Abstract Objective: To observe the effects and complications of radioactive 125I seeds implantation brachytherapy in the comprehensive treatment of pediatric orbital rhabdomyosarcoma. Methods: This was a retrospective case series study. Eight pediatric cases with orbital rhabdomyosarcoma were treated and followed up from January 2013 to January 2017 in the First Affiliated Hospital of Zhengzhou University. All pediatric patients were treated by surgery, and were diagnosed by pathological examination. There were 6 cases with the embryonal type and 2 cases with the acinar type according to the histopathological classification standard developed by WHO. Based on the Intergroup Rhabdomyosarcoma Study Group (IRSG) stages: 1 case was in stage Ⅰ, 3 cases were in stage Ⅱ, and 4 cases were in stage Ⅲ. All children received standard chemotherapy in pediatrics, and radioactive 125I seeds implantation brachytherapy was planned 1 month after resection. The curative effects and radiation complications were observed. Results: The tumors of 4 patients were completely and cleanly removed in the surgeries, and the others were not. Seven cases completed the comprehensive treatments. The 4-year tumor-free survival rate was 100%, except for 1 patient who did not complete the original chemotherapy plan. This patient eventually died due to brain metastases even though the orbital area was controlled. Follow-up was conducted with a median follow-up time of 48 months (37 to 66 months). Puncture complication: There was 1 case with a puncture hemorrhage. The short-term complications of radiotherapy (less than 6 months): There were 5 cases with irritating corneal symptoms and eyelashes and eyebrows missing, and 2 cases with local skin pigmentation. The long-term complications of radiotherapy (after 6 months): There were 5 cases with local skin pigmentation, 5 cases with ocular surface neovascularization and visual loss, 4 cases with subcutaneous atrophy and sclerosis, 3 cases with corneal irritating symptoms, 2 cases with eyelashes and eyebrows missing, and 2 cases with neovascular glaucoma. The eyeball of 1 patient was removed because of corneal ulcer and perforation. All of the pediatric patients had no abnormalities in the orbital or facial bones. The eyeballs remained intact in 6 cases among the 7 surviving children, and visual acuity was not affected in 3 cases. Conclusions: Pediatric orbital rhabdomyosarcoma that is limited can be treated better by surgery, chemotherapy and radioactive 125I seeds implantation brachytherapy, but the unique complications of radioactive 125I seeds need further study.

Key words： orbital rhabdomyosarcoma seeds implantation curative effects complications

Received: 05 December 2019

Corresponding Authors: Yu Zhu, Department of Ophthalmology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China (Email: 13673666718@163.com)

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https://www.cjoovs.com/EN/10.3760/cma.j.cn115909-20191205-00324 OR https://www.cjoovs.com/EN/Y2020/V22/I4/293

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