Aoyama Akihiro, Bando Toru, Okubo Kenichi, Wada Hiromi
Department of Thoracic Surgery, Kyoto University, Kyoto, Japan.
Nihon Geka Gakkai Zasshi. 2006 Nov;107(6):284-7.
Mediastinal germ cell tumor (MGCT) is histologically similar to, but is different from that in gonad glands. As to therapy, mature teratoma can be cured by resection alone. But cisplatin-based chemotherapy, often together with resection and radiation, has been playing a primary role in managing malignant MGCT consisting of seminoma and non-seminomatous MGCT. Consequently, comparably high cure rate in MGCT has been achieved. Treatment decisions should be based on the available evidence mainly obtained by retrospective studies because of the rarity of the entity. In this article, we reviewed the current strategy for MGCT, and described the outcome of 30 cases of malignant MGCT in our institution, in addition to presenting a case of nonseminomatous MGCT. Seventeen of 18 patients with malignant MGCT survived after surgery with cisplatin-based chemotherapy, while only 3 of 12 survived before cisplatin was introduced. In non-seminomatous MGCT, we now adopt cisplatin-based chemotherapy followed by surgery, including high-dose chemotherapy with peripheral blood stem cell transplantation to obtain the normalization of tumor markers. Additional chemotherapy is considered, if viable cells are found in resected specimen.
纵隔生殖细胞肿瘤（MGCT）在组织学上与性腺中的肿瘤相似，但又有所不同。在治疗方面，成熟畸胎瘤仅通过手术切除即可治愈。但是，以顺铂为基础的化疗，通常联合手术和放疗，在治疗由精原细胞瘤和非精原细胞瘤组成的恶性MGCT中发挥着主要作用。因此，MGCT已实现了相当高的治愈率。由于该疾病罕见，治疗决策应主要基于通过回顾性研究获得的现有证据。在本文中，我们回顾了MGCT的当前治疗策略，描述了我们机构30例恶性MGCT的治疗结果，并展示了1例非精原细胞瘤MGCT病例。18例恶性MGCT患者中有17例在接受基于顺铂的化疗手术后存活，而在引入顺铂之前，12例患者中只有3例存活。在非精原细胞瘤MGCT中，我们现在采用基于顺铂的化疗，然后进行手术，包括外周血干细胞移植的大剂量化疗，以实现肿瘤标志物的正常化。如果在切除标本中发现存活细胞，则考虑追加化疗。
