Shibamoto Y, Takahashi M, Sasai K
Department of Oncology, Chest Disease Research Institute, Kyoto University, Japan.
Int J Radiat Oncol Biol Phys. 1997 Feb 1;37(3):505-10. doi: 10.1016/s0360-3016(96)00611-6.
The limited information in the literature suggests that intracranial germinoma with syncytiotrophoblastic giant cells (STGC) producing human chorionic gonadotropin (HCG) is associated with a higher recurrence rate compared with pure germinoma producing no HCG. To determine whether the poorer prognosis for germinoma with STGC is an inevitable finding, we retrospectively analyzed data for our patients.
Data were analyzed for 44 patients who had pretreatment examination of HCG titers in the serum and/or cerebrospinal fluid (CSF) and underwent radiotherapy between 1978 and 1993. The diagnosis of germinoma was made histologically in 19 patients and clinically in 25 according to the established criteria. The treatment volume was the primary tumor site in 9 patients, the cerebrospinal axis in 29, and other in 6. The median follow-up period was 90 months.
Twenty (45%) of the 44 patients had elevated HCG titer. The abnormal HCG levels ranged from 4.9 to 189 mIU/ml (median: 18 mIU/ml) in serum and 8.2 to 660 mIU/ml (median: 26 mIU/ml) in CSF. No difference was found between the two groups in any patient or treatment characteristics including tumor size and incidence of CSF dissemination. The mean radiation dose to the primary tumor site was 46.4 Gy for pure germinoma and 47.5 Gy for germinoma with STGC. The 10-year survival and relapse-free survival rates were both 100% for the patients with germinoma with STGC and both 89% for those with pure germinoma. Among these patients, only two with pure germinoma developed recurrence.
Our data suggest that the prognosis of intracranial germinoma with STGC treated with adequate radiation therapy does not differ from that of pure germinoma. Our current policy of delivering 40-45 Gy for tumors < 4 cm in diameter seems to be a reasonable treatment for germinoma with STGC.
文献中的有限信息表明，与不产生人绒毛膜促性腺激素（HCG）的纯生殖细胞瘤相比，伴有合体滋养层巨细胞（STGC）并产生HCG的颅内生殖细胞瘤复发率更高。为了确定伴有STGC的生殖细胞瘤预后较差是否是必然结果，我们对患者数据进行了回顾性分析。
分析了1978年至1993年间44例患者的数据，这些患者在治疗前检测了血清和/或脑脊液（CSF）中的HCG滴度并接受了放疗。根据既定标准，19例患者经组织学诊断为生殖细胞瘤，25例为临床诊断。9例患者的治疗靶区为原发肿瘤部位，29例为脑脊液轴，6例为其他部位。中位随访期为90个月。
44例患者中有20例（45%）HCG滴度升高。血清中异常HCG水平为4.9至189 mIU/ml（中位数：18 mIU/ml），脑脊液中为8.2至660 mIU/ml（中位数：26 mIU/ml）。两组在任何患者或治疗特征（包括肿瘤大小和脑脊液播散发生率）方面均未发现差异。纯生殖细胞瘤原发肿瘤部位的平均放射剂量为46.4 Gy，伴有STGC的生殖细胞瘤为47.5 Gy。伴有STGC的生殖细胞瘤患者的10年生存率和无复发生存率均为100%，纯生殖细胞瘤患者均为89%。在这些患者中，只有2例纯生殖细胞瘤患者复发。
我们的数据表明，接受适当放疗的伴有STGC的颅内生殖细胞瘤的预后与纯生殖细胞瘤无异。我们目前对于直径<4 cm肿瘤给予40 - 45 Gy的治疗策略似乎是伴有STGC的生殖细胞瘤的合理治疗方法。
