Choi J U, Kim D S, Chung S S, Kim T S
Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Childs Nerv Syst. 1998 Jan-Feb;14(1-2):41-8. doi: 10.1007/s003810050173.
The authors retrospectively analyzed 107 patients with primary intracranial germ cell tumor (GCT), who were treated at the Department of Neurosurgery, Yonsei Medical Center between January 1986 and January 1996. The incidence of GCT was 2.8% in pediatric patients with intracranial tumor. Of the 107 tumors, 60 were located in the pineal region, 30 in the suprasellar region, 16 in basal ganglia or the thalamic region, and 1 in the posterior fossa. The 60 pineal GCT consisted of 39 germinomas (29 pure germinomas, 6 germinomas with STGC, 4 germinomas mixed with teratoma), 5 mature teratomas, and 16 nongerminomatous GCT. Thirty patients underwent surgery: their operations took the form of total resection in 14 cases, subtotal resection in 10, and biopsy in 6. Thirty patients (27 with germinomas, 3 with endodermal sinus tumors) were managed without surgery on the basis of radiological findings and tumor markers. The 5-year survival was 91% for 39 patients with germinomas, 80% for 5 with mature teratomas, and 49% for 16 with nongerminomatous GCT. Univariate analysis of prognostic factors with the Kaplan-Meier survival curve showed that histological tumor type, radiological findings, results of tumor marker studies, and response to trial radiation or chemotherapy were highly correlated with outcome. Chemotherapy was beneficial as the method of trial treatment in pineal GCT and treatment in recurrent tumors. The administration of trial chemotherapy or radiotherapy without tissue biopsy is well justified as a treatment modality in pineal GCT suspected on the basis of radiological findings and tumor marker studies. Aggressive multimodality approaches with surgery, radiotherapy, and chemotherapy are necessary to improve the outcome in these tumors. We propose new protocol for treatment of germ cell tumors in the pineal region, which is based on a minimally invasive approach.
作者回顾性分析了1986年1月至1996年1月在延世大学医学中心神经外科接受治疗的107例原发性颅内生殖细胞肿瘤（GCT）患者。GCT在小儿颅内肿瘤患者中的发病率为2.8%。在这107例肿瘤中，60例位于松果体区，30例位于鞍上区，16例位于基底节或丘脑区，1例位于后颅窝。60例松果体GCT包括39例生殖细胞瘤（29例单纯生殖细胞瘤、6例伴有STGC的生殖细胞瘤、4例与畸胎瘤混合的生殖细胞瘤）、5例成熟畸胎瘤和16例非生殖细胞性GCT。30例患者接受了手术：其中14例为全切除，10例为次全切除，6例为活检。30例患者（27例生殖细胞瘤、3例内胚窦瘤）根据影像学检查结果和肿瘤标志物未接受手术治疗。39例生殖细胞瘤患者的5年生存率为91%，5例成熟畸胎瘤患者为80%，16例非生殖细胞性GCT患者为49%。采用Kaplan-Meier生存曲线对预后因素进行单因素分析显示，组织学肿瘤类型、影像学检查结果、肿瘤标志物研究结果以及对试验性放疗或化疗的反应与预后高度相关。化疗作为松果体GCT试验性治疗方法和复发性肿瘤的治疗方法是有益的。在根据影像学检查结果和肿瘤标志物研究怀疑为松果体GCT的情况下，在未进行组织活检的情况下给予试验性化疗或放疗作为一种治疗方式是合理的。积极的多模式治疗方法，包括手术、放疗和化疗，对于改善这些肿瘤的预后是必要的。我们提出了基于微创方法的松果体区生殖细胞肿瘤治疗新方案。
