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Léčba vitreálního seedingu retinoblastomu. Přehled


Authors: Martina Kodetová 1;  Karel Švojgr 2;  Jakub Širc 3;  Jaroslav Vaněček 1;  Pavel Pochop 1
Authors‘ workplace: Oční klinika dětí a dospělých 2. LF UK a FN Motol Praha 1;  Klinika dětské hematologie a onkologie 2. LF UK a FN Motol Praha 2;  Ústav makromolekulární chemie Akademie věd ČR, v. v. i. Praha 3
Published in: Čes. a slov. Oftal., 80, 2024, No. 3, p. 123-127
Category: Review
doi: https://doi.org/10.31348/2023/35

Overview

Retinoblastom je nejčastějším nitroočním maligním nádorem v dětském věku. Zásadní parametr určující stupeň retinoblastomu dle mezinárodní klasifikace retinoblastomu představuje seeding, neboli disperze nádorových partikulí do přilehlých kompartmentů. V článku jsme se zaměřili na vitreální seeding, jeden z hlavních limitujících faktorů úspěšné léčby retinoblastomu, při níž je zachován bulbus tzv. „eye-preservation treatment“. Článek shrnuje přehled vývoje léčby vitreálního seedingu retinoblastomu, zavedených postupů a zároveň seznamuje s novinkami na úrovni výzkumu. Zavedení systémové chemoterapie v léčbě retinoblastomu koncem 90. let znamenalo významný přelom, který umožnil postupné opuštění externí radioterapie s jejími vedlejšími účinky. Docílené koncentrace chemoterapeutik ve sklivcovém prostoru při systémové chemoterapii však nejsou pro léčbu vitreálního seedingu dostatečné a toxické účinky systémově podávaných chemoterapeutik nejsou zanedbatelné. Významnou změnou byl nástup chemoterapie in situ s cíleným podáváním chemoterapeutik, a to intraarteriálně a intravitreálně, což přispělo k definitivní eradikaci externí radioterapie a omezení systémové chemoterapie. Ačkoliv vitreální seeding zůstává nejčastějším důvodem selhání intraarteriální chemoterapie, tato technika výrazně ovlivnila původní léčebné schéma retinoblastomových dětí. Nejvíce se však zasloužila o zvýšení pravděpodobnosti zachování oka i zrakových funkcí u pacientů s pokročilým nálezem intravitreální chemoterapie. Nadále probíhá mnoho prací na vývoji nových terapeutických technik, a to s použitím periokulární aplikace chemoterapeutika, imunoterapie, genové terapie či onkolytických virů, z nichž se některé jeví jako slibné, ale k rutinnímu využití nejsou zatím dokončeny klinické studie.

Klíčová slova:

retinoblastom – vitreální seeding – léčba zachovávající bulbus – intravitreální chemoterapie


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