Haddock M G, Schild S E, Scheithauer B W, Schomberg P J
Division of Radiation Oncology, Mayo Clinic and Mayo Medical School, Rochester, MN 55905, USA.
Int J Radiat Oncol Biol Phys. 1997 Jul 15;38(5):915-23. doi: 10.1016/s0360-3016(97)00135-1.
To evaluate survival and patterns of recurrence in patients with primary central nervous system germinoma treated with radiation therapy.
Data regarding 48 patients with histologically confirmed, primary central nervous system germinoma were reviewed. All had been operated on at the Mayo Clinic between the years 1935 and 1993. Thirty-two patients (67%) were treated since 1973. The study group included 39 males and 9 females, with a median age at diagnosis of 17 years (range, 6-42 years). Twelve patients (25%) were treated with craniospinal axis irradiation, 11 (23%) received whole-brain irradiation without spinal axis irradiation, and 24 (50%) underwent partial-brain irradiation. Treatment volumes were unknown in one patient. The median dose to the primary tumor was 44.00 Gy (range, 7.44-59.40 Gy). The median follow-up was 5.5 years (range, 4 months to 37 years).
Actuarial 5-year and 10-year survival for the entire study group of patients was 80%. There was a trend toward improved survival in patients treated after 1973 (introduction of computed tomography) with 5-year and 10-year survival of 91% vs. 63% in prior years (p = 0.07). For the group of 31 patients treated since 1973 with known treatment volumes, the spinal axis failure rate at 5 years was 49% for patients treated with partial brain fields (11 patients) vs. 0% for those having undergone whole brain (10 patients) or craniospinal axis (10 patients) irradiation (p = 0.007). The rate of brain failure was also significantly higher in patients receiving less than whole-brain irradiation; at 5 years, 45% of the patients treated with partial-brain fields had intracranial recurrence of disease compared to 6 % of patients treated with craniospinal axis or whole-brain irradiation (p = 0.01). Among the 32 modern era patients, the rate of brain failure was higher in patients who received doses less than 40 Gy (median dose, 48.55 Gy; range, 30.60-59.40 Gy) to the primary tumor (5-year brain failure rate 52% vs. 11%, p = 0.002).
The long-term survival of patients with histologically proven CNS germinoma treated with radiation is excellent. Whole-brain or craniospinal axis irradiation appears to result in fewer spine and brain failures than does partial-brain irradiation. Furthermore, the administration of doses greater than 40 Gy to the primary tumor is associated with better local control.
评估接受放射治疗的原发性中枢神经系统生殖细胞瘤患者的生存率和复发模式。
回顾了48例经组织学确诊的原发性中枢神经系统生殖细胞瘤患者的数据。所有患者均于1935年至1993年间在梅奥诊所接受手术。自1973年以来治疗了32例患者（67%）。研究组包括39例男性和9例女性，诊断时的中位年龄为17岁（范围6 - 42岁）。12例患者（25%）接受了全脑脊髓轴照射，11例（23%）接受了全脑照射但未进行脊髓轴照射，24例（50%）接受了局部脑照射。1例患者的治疗体积未知。原发肿瘤的中位剂量为44.00 Gy（范围7.44 - 59.40 Gy）。中位随访时间为5.5年（范围4个月至37年）。
整个研究组患者的5年和10年精算生存率为80%。1973年（计算机断层扫描引入）后接受治疗的患者有生存率提高的趋势，5年和10年生存率分别为91%和63%，而之前年份为63%（p = 0.07）。对于1973年以来已知治疗体积的31例患者，局部脑野治疗的患者（11例）5年脊髓轴失败率为49%，而接受全脑（10例）或全脑脊髓轴照射（10例）的患者为0%（p = 0.007）。接受少于全脑照射的患者脑失败率也显著更高；5年时，接受局部脑野治疗的患者中有45%发生颅内疾病复发，而接受全脑脊髓轴或全脑照射的患者为6%（p = 0.01）。在32例现代患者中，原发肿瘤接受剂量小于40 Gy（中位剂量48.55 Gy；范围30.60 - 59.40 Gy）的患者脑失败率更高（5年脑失败率52%对11%，p = 0.002））。
经组织学证实的中枢神经系统生殖细胞瘤患者接受放射治疗后的长期生存率良好。全脑或全脑脊髓轴照射似乎比局部脑照射导致的脊髓和脑失败更少。此外，对原发肿瘤给予大于40 Gy的剂量与更好的局部控制相关。
