对于磁共振成像（MR）上无脊髓病变但细胞学检查阳性的生殖细胞瘤进行全脑全脊髓放疗的必要性——一场争议。
Necessity for craniospinal irradiation of germinoma with positive cytology without spinal lesion on MR imaging-A controversy.
作者信息
Kanamori Masayuki, Takami Hirokazu, Suzuki Tomonari, Tominaga Teiji, Kurihara Jun, Tanaka Shota, Hatazaki Seiji, Nagane Motoo, Matsuda Masahide, Yoshino Atsuo, Natsumeda Manabu, Yamaoka Masayoshi, Kagawa Naoki, Akiyama Yukinori, Fukai Junya, Negoto Tetsuya, Shibahara Ichiyo, Tanaka Kazuhiro, Inoue Akihiro, Mase Mitsuhiro, Tomita Takahiro, Kuga Daisuke, Kijima Noriyuki, Fukami Tadateru, Nakahara Yukiko, Natsume Atsushi, Yoshimoto Koji, Keino Dai, Tokuyama Tsutomu, Asano Kenichiro, Ujifuku Kenta, Abe Hiroshi, Nakada Mitsutoshi, Matsuda Ken-Ichiro, Arakawa Yoshiki, Ikeda Naokado, Narita Yoshitaka, Shinojima Naoki, Kambe Atsushi, Nonaka Masahiko, Izumoto Shuichi, Kawanishi Yu, Kanaya Kohei, Nomura Sadahiro, Nakajima Kohei, Yamamoto Shohei, Terashima Keita, Ichimura Koichi, Nishikawa Ryo
机构信息
Department of Neurosurgery, Tohoku University Graduate School Medicine, Sendai, Miyagi, Japan.
Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
出版信息
Neurooncol Adv. 2021 Jun 25;3(1):vdab086. doi: 10.1093/noajnl/vdab086. eCollection 2021 Jan-Dec.
BACKGROUND
Cerebrospinal fluid (CSF) cytology and spinal MR imaging are routinely performed for staging before treatment of intracranial germinoma. However, the interpretation of the results of CSF cytology poses 2 unresolved clinical questions: (1) Does positive CSF cytology correlate with the presence of spinal lesion before treatment? and (2) Is craniospinal irradiation (CSI) necessary for patients with positive CSF cytology in the absence of spinal lesion?
METHODS
Multicenter retrospective analyses were performed based on a questionnaire on clinical features, spinal MR imaging finding, results of CSF cytology, treatments, and outcomes which was sent to 86 neurosurgical and 35 pediatrics departments in Japan. Pretreatment frequencies of spinal lesion on MR imaging were compared between the patients with positive and negative cytology. Progression-free survival (PFS) rates were compared between patients with positive CSF cytology without spinal lesion on MR imaging treated with CSI and with whole brain or whole ventricular irradiation (non-CSI).
RESULTS
A total of 92 germinoma patients from 45 institutes were evaluated by both CSF cytology and spinal MR images, but 26 patients were excluded because of tumor markers, the timing of CSF sampling or incomplete estimation of spinal lesion. Of the remaining 66 germinoma patients, spinal lesions were equally identified in patients with negative CSF cytology and positive cytology (4.9% and 8.0%, respectively). Eleven patients treated with non-CSI had excellent PFS comparable to 11 patients treated with CSI.
CONCLUSION
CSI is unnecessary for germinoma patients with positive CSF cytology without spinal lesions on MR imaging.
背景
在颅内生殖细胞瘤治疗前进行分期时，常规会进行脑脊液（CSF）细胞学检查和脊髓磁共振成像（MR成像）。然而，CSF细胞学检查结果的解读存在两个尚未解决的临床问题：（1）CSF细胞学检查阳性是否与治疗前脊髓病变的存在相关？（2）对于CSF细胞学检查阳性但无脊髓病变的患者，是否需要进行全脑脊髓放疗（CSI）？
方法
基于一份关于临床特征、脊髓MR成像结果、CSF细胞学检查结果、治疗及预后的调查问卷，对日本86个神经外科和35个儿科科室进行了多中心回顾性分析。比较了细胞学检查阳性和阴性患者MR成像上脊髓病变的治疗前频率。对MR成像上无脊髓病变但CSF细胞学检查阳性的患者，比较了接受CSI治疗与接受全脑或全脑室放疗（非CSI）患者的无进展生存期（PFS）率。
结果
共有来自45个机构的92例生殖细胞瘤患者接受了CSF细胞学检查和脊髓MR成像评估，但26例患者因肿瘤标志物、CSF采样时间或脊髓病变评估不完整而被排除。在其余66例生殖细胞瘤患者中，CSF细胞学检查阴性和阳性患者中脊髓病变的检出率相当（分别为4.9%和8.0%）。11例接受非CSI治疗的患者的PFS良好，与11例接受CSI治疗的患者相当。
结论
对于MR成像上无脊髓病变但CSF细胞学检查阳性的生殖细胞瘤患者，无需进行CSI。
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