Kamoshima Yuuta, Sawamura Yutaka, Ikeda Jun, Shirato Hiroki, Aoyama Hidefumi
Department of Neurosurgery, Hokkaido University Hospital, North-15, West-7, Kita-ku, Sapporo 060-8638, Japan.
J Neurooncol. 2008 Nov;90(2):205-11. doi: 10.1007/s11060-008-9649-7. Epub 2008 Jul 5.
Central nervous system (CNS) germinoma is a curable tumor and its recurrence rate after initial therapy may be approximately 10% or higher. This study elucidates the time-course of recurrence and results of salvage therapy. Twenty-five patients with recurrent germinoma treated at Hokkaido University Hospital were retrospectively reviewed. The median age at initial treatment was 12 years (range: 8-37). All patients had been tumor-free for at least 6 months after the initial treatment. The median follow-up period was 134 months (range: 44-338). The median age at first recurrence was 18 years and the median time to the first recurrence was 50 months. Among the patients, 9 (36%) had the first recurrence at 60 months or later. The latest recurrence in a patient occurred 230 months after the initial treatment. The results of salvage therapy were estimated in all 25 patients. Seventeen patients (68%) were salvaged and were tumor-free at the final observation. The remaining 8 patients died of disease. At first recurrence, 11 patients were treated using radiation therapy with or without surgery and 7 out of the 11 patients died due to the recurrent tumor. On the other hand, 13 patients who received salvage chemotherapy and radiotherapy were tumor-free at the last follow-up. In conclusion, late recurrence is not a rare event in patients with CNS germinoma. To identify a true cure rate of this disease, a 10-year or longer observation period may be required. As a salvage therapy, platinum-based chemotherapy followed by wide-field low-dose radiation therapy appears to be effective.
中枢神经系统（CNS）生殖细胞瘤是一种可治愈的肿瘤，其初始治疗后的复发率可能约为10%或更高。本研究阐明了复发的时间进程及挽救治疗的结果。对北海道大学医院治疗的25例复发生殖细胞瘤患者进行了回顾性分析。初始治疗时的中位年龄为12岁（范围：8 - 37岁）。所有患者在初始治疗后至少6个月无肿瘤。中位随访期为134个月（范围：44 - 338个月）。首次复发时的中位年龄为18岁，首次复发的中位时间为50个月。其中，9例（36%）患者在60个月或更晚出现首次复发。一名患者的最晚复发发生在初始治疗后230个月。评估了所有25例患者的挽救治疗结果。17例（68%）患者得到挽救，在最后一次观察时无肿瘤。其余8例患者死于疾病。首次复发时，11例患者接受了放疗，部分联合手术，其中11例中有7例因复发性肿瘤死亡。另一方面，13例接受挽救性化疗和放疗的患者在最后一次随访时无肿瘤。总之，晚期复发在CNS生殖细胞瘤患者中并非罕见事件。为确定该疾病的真正治愈率，可能需要10年或更长的观察期。作为挽救治疗，铂类化疗后行全野低剂量放疗似乎有效。
