Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Int J Radiat Oncol Biol Phys. 2012 Nov 1;84(3):625-31. doi: 10.1016/j.ijrobp.2011.12.077. Epub 2012 Mar 13.
To evaluate whether a multimodal approach including craniospinal irradiation (CSI) improves treatment outcome in nongerminomatous germ cell tumor (NGGCT) patients.
We reviewed the records of 32 patients with NGGCTs. Fourteen patients belonged to the intermediate prognosis group (immature teratoma, teratoma with malignant transformation, and mixed tumors mainly composed of germinoma or teratoma), and 18 patients belonged to the poor prognosis group (other highly malignant tumors). Patients with pure germinoma or mature teratoma were excluded from this study. Nineteen patients were treated with a combination of surgery, chemotherapy, and radiotherapy (RT); 9 patients received chemotherapy plus RT; 3 patients received surgery plus RT; and 1 patient received RT alone. Twenty-seven patients received CSI with a median of 36 Gy (range, 20-41 Gy) plus focal boost of 18-30.6 Gy, and 5 patients received whole-brain RT (WBRT) (20-36 Gy) or focal RT (50.4-54 Gy). The rate of total and subtotal resection was 71.9%. The median follow-up for surviving patients was 121 months.
Treatment failed in 7 patients. Three of the 5 patients who received focal RT or WBRT had local failure. Four cerebrospinal fluid (CSF) failures occurred after CSI. No failure occurred in the intermediate prognosis group. Ten-year recurrence-free survival (RFS) and overall survival (OS) for all patients were 77.6% and 74.6%, respectively. Ten-year RFS for the intermediate and poor prognosis groups were 100% and 61.1%, respectively (p = 0.012). OS for the two groups were 85.1% and 66.7%, respectively (p = 0.215). Tumor histology and CSI were significant prognostic factors for RFS, and CSI was significantly associated with OS.
A multimodal approach was effective for treating NGGCTs. CSI should be considered for patients with poor prognostic histology.
评估包括颅脑脊髓照射（CSI）的多模态方法是否能改善非生殖细胞瘤生殖细胞肿瘤（NGGCT）患者的治疗结果。
我们回顾了 32 例 NGGCT 患者的记录。14 例患者属于中预后组（未成熟畸胎瘤、畸胎瘤伴恶性转化和主要由生殖细胞瘤或畸胎瘤组成的混合瘤），18 例患者属于差预后组（其他高度恶性肿瘤）。本研究排除了单纯生殖细胞瘤或成熟畸胎瘤的患者。19 例患者接受了手术、化疗和放疗（RT）的联合治疗；9 例患者接受化疗加 RT；3 例患者接受手术加 RT；1 例患者接受 RT 单独治疗。27 例患者接受 CSI，中位数剂量为 36 Gy（范围，20-41 Gy），加 18-30.6 Gy 的局部加量，5 例患者接受全脑 RT（WBRT）（20-36 Gy）或局部 RT（50.4-54 Gy）。完全和次全切除术的比例为 71.9%。存活患者的中位随访时间为 121 个月。
7 例患者治疗失败。5 例接受局部 RT 或 WBRT 的患者中有 3 例发生局部失败。4 例 CSF 失败发生在 CSI 后。中预后组无失败。所有患者的 10 年无复发生存（RFS）和总生存（OS）分别为 77.6%和 74.6%。中预后组和差预后组的 10 年 RFS 分别为 100%和 61.1%（p = 0.012）。两组的 OS 分别为 85.1%和 66.7%（p = 0.215）。肿瘤组织学和 CSI 是 RFS 的显著预后因素，CSI 与 OS 显著相关。
多模态方法对治疗 NGGCT 有效。对于预后不良的组织学患者，应考虑 CSI。
