Sham J S, Fu K H, Chiu C S, Lau W H, Choi P H, Khin M A, Tung S Y, Mok C K, Choy D
Department of Radiotherapy and Oncology, Queen Mary Hospital, Hong Kong.
Cancer. 1989 Aug 1;64(3):756-61. doi: 10.1002/1097-0142(19890801)64:3<756::aid-cncr2820640331>3.0.co;2-m.
Ten male patients with extensive primary endodermal sinus tumor of the mediastinum were treated with chemotherapy (with or without surgical excision and radiation therapy) between 1977 and 1985. Three patients, treated with cyclophosphamide-vincristine-based chemotherapy, died 1.5, 2.5, and 6.0 months, respectively, after initial diagnosis. Of the seven patients treated with cisplatin-based chemotherapy, one patient died of septicemia at 2.5 months after diagnosis and was disease-free at autopsy examination. Three other patients died of progressive disease at 7.0, 13.0, and 14.0 months, respectively. The three survivors remain alive at 17.0, 31.0, and 40.0 months from diagnosis; all are without evidence of disease. Of the three patients who underwent excision of the residual mediastinal tumor after cisplatin-based chemotherapy, persistent local disease was found in two patients. One of these two patients died of recurrent disease. All surviving patients had surgical resection of the tumor either before or after cisplatin-based chemotherapy, with or without radiotherapy and the timing of therapeutic interventions was guided by changes in the serum alpha-fetoprotein concentrations after initial therapy and during follow-up. Our experience suggests that the optimal management of patients with primary mediastinal endodermal sinus tumor requires an aggressive multidisciplinary approach guided by the extent of the tumor and the serum tumor marker levels.
1977年至1985年间，10名患有广泛原发性纵隔内胚窦瘤的男性患者接受了化疗（联合或不联合手术切除及放射治疗）。3名接受基于环磷酰胺-长春新碱化疗的患者分别在初诊后1.5、2.5和6.0个月死亡。在7名接受基于顺铂化疗的患者中，1名患者在诊断后2.5个月死于败血症，尸检时无疾病迹象。另外3名患者分别在7.0、13.0和14.0个月死于疾病进展。3名幸存者自诊断后17.0、31.0和40.0个月仍存活；均无疾病证据。在3名接受基于顺铂化疗后切除残留纵隔肿瘤的患者中，2名患者发现有持续性局部疾病。这两名患者中的1名死于复发性疾病。所有存活患者在基于顺铂化疗之前或之后均接受了肿瘤手术切除，联合或不联合放疗，治疗干预的时机根据初始治疗后及随访期间血清甲胎蛋白浓度的变化来指导。我们的经验表明，原发性纵隔内胚窦瘤患者的最佳治疗需要以肿瘤范围和血清肿瘤标志物水平为指导的积极多学科方法。
