Gale J, Mead G M, Simmonds P D
CRC Wessex Medical Oncology Unit, Royal South Hants Hospital, Southampton SO14 OYG, UK.
Clin Oncol (R Coll Radiol). 2002 Dec;14(6):481-90. doi: 10.1053/clon.2002.0167.
To review the management and clinical outcome of 10 patients, presenting to a single centre with symptoms and signs of spinal cord or cauda equina compression secondary to epidural metastatic disease from a testicular germ cell cancer.
Clinical data regarding presenting history, physical examination, staging investigations, treatment and clinical outcome were retrospectively obtained from patient records.
Eight patients exhibited neurological deficits at the time of initial presentation of germ cell cancer or as a first manifestation of relapse following dog leg irradiation. Four of these cases were managed with chemotherapy alone, with excellent neurological recovery, whilst four underwent decompressive laminectomy--in three cases prior to referral and in one case after commencing chemotherapy. Five of the eight patients relapsed. Four required further chemotherapy (high dose in two cases). The remaining patient underwent thoracic surgery, with resection of teratoma differentiated. Six of the eight patients are currently alive and disease free. Two patients had chemorefractory disease and died, though one was treated in the pre-cisplatin era. Two patients presented with cord compression as a feature of disease relapse following chemotherapy, and were managed with radiotherapy alone in an attempt to achieve local disease control and limit neurological dysfunction. However, both subsequently died with progressive disease.
Epidural spinal cord or cauda equina compression is a rare complication of metastatic germ cell cancer, which can be successfully managed in chemo-naive patients with good neurological outcome.
回顾10例因睾丸生殖细胞癌硬膜外转移导致脊髓或马尾神经受压症状和体征而就诊于单一中心患者的治疗及临床结果。
从患者记录中回顾性获取有关现病史、体格检查、分期检查、治疗及临床结果的临床资料。
8例患者在初次出现生殖细胞癌时或在“狗腿”照射后复发的首发表现时出现神经功能缺损。其中4例仅接受化疗，神经功能恢复良好，而4例接受了减压性椎板切除术——3例在转诊前，1例在开始化疗后。8例患者中有5例复发。4例需要进一步化疗（2例为高剂量）。其余患者接受了胸外科手术，切除了成熟畸胎瘤。8例患者中有6例目前存活且无疾病。2例患者化疗难治性疾病死亡，不过1例在顺铂时代之前接受治疗。2例患者在化疗后疾病复发时出现脊髓压迫，仅接受放疗以试图实现局部疾病控制并限制神经功能障碍。然而，两者随后均因疾病进展死亡。
硬膜外脊髓或马尾神经受压是转移性生殖细胞癌的罕见并发症，在初治患者中可成功治疗，神经功能结果良好。
