Nakamura Hideo, Takeshima Hideo, Makino Keishi, Kochi Masato, Ushio Yukitaka, Kuratsu Jun-Ichi
Department of Neurosurgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo Kumamoto 860-8556, Japan.
Acta Oncol. 2006;45(4):476-83. doi: 10.1080/02841860500519778.
Between 1975 and 2005, we treated 52 newly diagnosed germinoma patients. Until 1991, patients with pure germinomas or germinomas with syncytiotrophoblastic giant cells (STGCs) received whole-brain radiotherapy only. Of the 52 patients, 30 were treated with a reduced radiation volume and combined chemotherapy; seven of these received local irradiation with 24 Gy, two received whole-brain (30 Gy) plus local irradiation (20 Gy), 16 received extended local irradiation delivered to the whole ventricles (30 Gy) plus local (20 Gy) irradiation, and five received extended local irradiation (24 Gy). Of the 30 patients treated with a reduced radiation volume and combined chemotherapy, four experienced tumor recurrence; three patients had been treated with 24 Gy of local radiotherapy and one had received extended local (30 Gy) plus local (20 Gy) irradiation in addition to chemotherapy. In these patients, the delivered radiotherapy was inadequate and the origin of the recurrent tumors was outside the radiation field. None of the patients who had received at least 24 Gy of whole ventricle radiotherapy combined with chemotherapy experienced tumor recurrence. In combination with chemotherapy, the delivery of irradiation covering the ventricles effectively reduced the incidence of tumor recurrence in patients with germinomas or germinomas with STGCs.
1975年至2005年间，我们共治疗了52例新诊断的生殖细胞瘤患者。直到1991年，单纯生殖细胞瘤或伴有合体滋养层巨细胞（STGCs）的生殖细胞瘤患者仅接受全脑放疗。在这52例患者中，30例接受了缩小放疗范围并联合化疗；其中7例接受24 Gy的局部照射，2例接受全脑（30 Gy）加局部照射（20 Gy），16例接受全脑室扩大局部照射（30 Gy）加局部（20 Gy）照射，5例接受扩大局部照射（24 Gy）。在30例接受缩小放疗范围并联合化疗的患者中，4例出现肿瘤复发；3例接受了24 Gy的局部放疗，1例除化疗外还接受了扩大局部（30 Gy）加局部（20 Gy）照射。在这些患者中，放疗剂量不足，复发肿瘤的起源在放疗野之外。接受至少24 Gy全脑室放疗联合化疗的患者均未出现肿瘤复发。联合化疗时，覆盖脑室的放疗可有效降低生殖细胞瘤或伴有STGCs的生殖细胞瘤患者的肿瘤复发率。
