摘要
目的 探讨颅内生殖细胞瘤经过化疗并辅以中低剂量放疗后的远期疗效。方法 对1993～ 1996年收治的 45例颅内生殖细胞瘤患者进行静脉化疗并辅以中低剂量放疗 ,获得随访 39例。其中肿瘤位于松果体区 2 4例 ,松果体区并鞍区 8例 ,鞍区 4例 ,松果体区并脑室内 3例。化疗 4d为一疗程 ,使用药物为长春新碱、甲氨蝶呤、平阳霉素及顺铂。用药后每周化验 2次血常规 ,1次血生化 ,以观察周围血象变化及心、肝、肾功能情况 ,并进行针对性治疗。 4周后如血常规及血生化的各项指标均正常 ,再行第二疗程化疗。两个疗程结束后 1个月 ,在肿瘤病灶局部补充中低剂量 ( 2 5～ 35Gy)的放疗。每个疗程间进行CT或MRI检查 ,观察肿瘤消退的情况。结果 39例患者随访 5～ 8年 ,1例为手术加全剂量放疗后 2年肿瘤复发 ,此次化疗进行 2个疗程 ,但化疗后未再补充放疗 ,4年后肿瘤复发 ,家属放弃治疗 ,患者死亡。 1例化疗、放疗后 5年肿瘤复发 ,再行 2个疗程化疗 ,肿瘤消退80 % ,目前每半年接受 1次化疗 ,病情平稳 ,生活自理。其余 37例 ( 95 % )化疗、放疗后 5～ 8年 ,复查MRI显示肿瘤无复发 ,患者生存质量良好 ,其中 30例学龄儿童生长发育及智力均未受影响。结论 静脉化疗辅以中低剂量放疗应为治疗颅内生殖细胞瘤的最佳方案。
Objective To evaluate the long-term effect of chemotherapy combined with radiotherapy in treatment of intracranial germinomas. Methods Chemotherapy combined with radiotherapy was given to 45 patients with intracranial germinomas, 24 in the pineal region, 8 in the pineal and suprasellar regions, 4 in the suprasellar region, and 3 in the pineal region and cerebral ventricle from December 1993 to December 1996. Vincristine (VCR), methotrexate (MTX), bleomycin and cisplatin were administered for 4 days as a course of treatment. Then blood routine examination was taken twice a week and blood biochemical examination was taken once a week. A repeat course of chemotherapy was started 4 weeks after if no abnormality in blood examination was found. Local radiotherapy was taken with low to middle dosage (25～35 Gy) 1～2 months after the second course of chemotherapy. CT and/or MRI examination are made regularly. 39 patients had been followed up for 5～8 years. Results Out of the 39 cases followed-up, one with the relapsing tumor had undergone operation and radiotherapy 2 years before and was given chemotherapy alone without radiotherapy re-relapsed and died in 4 years. One case relapsed 5 years after chemotherapy and radiotherapy and then was given chemotherapy for two more courses with the result of a shrinking of tumor by 80%. During the follow-up 37 patients (95%) survived without relapse of tumor and resumed their normal work or schooling. Conclusion Chemotherapy combined with local radiotherapy with low to middle dosage is the best choice for treatment of intracranial germinomas.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2003年第3期198-200,共3页
National Medical Journal of China
