Ono N, Isobe I, Uki J, Kurihara H, Shimizu T, Kohno K
Department of Neurosurgery, Gunma University School of Medicine, Japan.
Neurosurgery. 1994 Oct;35(4):615-20; discussion 620-1. doi: 10.1227/00006123-199410000-00006.
Nine germinoma patients are described who developed a recurrence after a complete response to radiation without adjuvant chemotherapy. Extraembryonic tumors producing alpha-fetoprotein and human chorionic gonadotropin were excluded from this study. Four patterns of recurrence are described with respect to mechanism and appropriate treatment. Type I germinoma recurrence, characterized by intracranial recurrence caused by an inadequate initial irradiation field was treated by total craniospinal irradiation. Type II recurrence, characterized by a benign teratoma caused by late growth of the teratoma component was treated by surgery alone. All patients with these patterns of recurrence are still alive. Type III local recurrence is characterized by human chorionic gonadotropin- or alpha-fetoprotein-producing tumors of extraembryonic origin. This pattern of recurrence should be treated by chemotherapy or radiosurgery, because all these patients died. Type IV germinoma recurrence consists of extraneural metastasis without evidence of intracranial recurrence. Two of these patients were treated with chemotherapy. In summary, four patients died after recurrence, whereas the remaining five patients survived. The classification of germinoma recurrence patterns should facilitate the selection of the most appropriate treatment. However, it has been difficult to identify the precise histopathology by biopsy or partial resection alone. Furthermore, chemotherapy is indicated in treating germinomas that have a ventriculoperitoneal shunt because of the risk of extraneural metastases.
本文描述了9例生殖细胞瘤患者，他们在接受放疗后完全缓解，但未接受辅助化疗，随后出现复发。本研究排除了产生甲胎蛋白和人绒毛膜促性腺激素的胚外肿瘤。根据复发机制和适当治疗方法，描述了4种复发模式。I型生殖细胞瘤复发，其特征为初始照射野不足导致颅内复发，采用全颅脊髓照射治疗。II型复发，其特征为由畸胎瘤成分晚期生长引起的良性畸胎瘤，仅采用手术治疗。所有具有这些复发模式的患者仍然存活。III型局部复发的特征是起源于胚外的产生人绒毛膜促性腺激素或甲胎蛋白的肿瘤。这种复发模式应采用化疗或放射外科治疗，因为所有这些患者均死亡。IV型生殖细胞瘤复发包括无颅内复发证据的神经外转移。其中2例患者接受了化疗。总之，4例患者复发后死亡，其余5例患者存活。生殖细胞瘤复发模式的分类应有助于选择最合适的治疗方法。然而，仅通过活检或部分切除很难确定精确的组织病理学。此外，由于存在神经外转移的风险，对于因脑室腹腔分流而患有生殖细胞瘤的患者，应进行化疗。
