Géczi L, Biron P, Droz J P
Kemoterápia C és Klinikai Farmakológiai Osztály, Országos Onkológiai Intézet, Budapest.
Orv Hetil. 2001 Aug 5;142(31):1673-9.
The aim of the authors is to present the risk factors and the risk factors based treatment strategy of germ cell tumors. They review the risk adapted treatment strategy of germ cell tumors using the treatment policy of the Léon Bérard Oncological Center and the current findings published. More than of 80% germ cell tumors may be cured by standard treatment. The treatment of stage I seminoma is lumboaortic radiotherapy and that of stage I non seminoma is either surveillance, retroperitoneal lymph node dissection or chemotherapy depending on the risk factors of extratesticular involvement (pure embryonal carcinoma, vascular invasion). The treatment of metastatic cases is chemotherapy: three cycles of bleomycin, etoposid, cisplatin of four cycles of the similar components without bleomycin for good risk patients, and four cycles bleomycin, etoposid and cisplatin in poor risk cases. The overall five year survival rates are 90 and 50% in cases of good and poor prognosis groups respectively. The indication of retroperitoneal lymph node dissection depends on the size of retroperitoneal spreading prior to chemotherapy and on the efficacy of chemotherapy. The second line salvage treatment is four cycles of a combination of vinblastin, ifosfamide and cisplatin. After salvage chemotherapy the resection of all residual masses is recommended. New drugs, such as gemcitabine, taxotere, oxaliplatin and high dose chemotherapy may bring further success, however these new treatment modalities are not available for clinical practice in Hungary. Risk adapted treatment for germ cell tumors decreasing the early and late toxicity's of conventional treatment may improve the patients quality of life, and may decrease the cost of standard treatment in Hungary. The said new medication and the use of high dose chemotherapy may further improve the chances of patients with poor and intermediate prognosis and of those who are resistant to the cisplatin based standard therapy.
作者的目的是介绍生殖细胞肿瘤的危险因素以及基于危险因素的治疗策略。他们使用里昂·贝拉尔肿瘤中心的治疗策略和已发表的最新研究结果，回顾了生殖细胞肿瘤的风险适应性治疗策略。超过80%的生殖细胞肿瘤可通过标准治疗治愈。I期精原细胞瘤的治疗是腰骶主动脉放疗，I期非精原细胞瘤的治疗根据睾丸外受累的危险因素（纯胚胎癌、血管侵犯），可选择观察、腹膜后淋巴结清扫或化疗。转移性病例的治疗是化疗：对于预后良好的患者，采用三个周期的博来霉素、依托泊苷、顺铂，或四个周期不含博来霉素的类似方案；对于预后不良的病例，采用四个周期的博来霉素、依托泊苷和顺铂。预后良好和不良组的总体五年生存率分别为90%和50%。腹膜后淋巴结清扫的指征取决于化疗前腹膜后扩散的大小和化疗的疗效。二线挽救治疗是四个周期的长春花碱、异环磷酰胺和顺铂联合方案。挽救化疗后，建议切除所有残留肿块。吉西他滨、多西他赛、奥沙利铂等新药以及高剂量化疗可能会带来更大的成功，然而在匈牙利这些新的治疗方式尚未应用于临床实践。生殖细胞肿瘤的风险适应性治疗降低了传统治疗的早期和晚期毒性，可能会改善患者的生活质量，并降低匈牙利标准治疗的成本。上述新药和高剂量化疗的使用可能会进一步提高预后不良和中等的患者以及对基于顺铂的标准治疗耐药患者的治愈机会。
