颅内生殖细胞瘤立体定向放射外科治疗失败模式和挽救性治疗的初步探讨

目的初步探讨立体定向放射初治颅内生殖细胞瘤的失败模式及挽救性治疗策略。方法回顾性分析17例接受立体定向放射治疗失败的颅内生殖细胞瘤患者的临床资料。研究治疗失败模式及挽救治疗手段。结果治疗失败时间为初治后3~24个月(中位8.5个月)。仅接受立体定向放射治疗的13例患者中,12例出现原发部位复发(6例合并颅内种植,1例合并脊髓种植),另1例出现颅内种植;接受序贯全脑或全中枢照射的4例患者,3例出现原发部位复发和颅内或脊髓种植,1例出现颅内种植。所有患者均接受挽救性治疗。全部患者均行多程含铂方案联合化疗,14例行放疗,3例未放疗,中位随访时间137.0个月,10年生存率为76.5%。结论对于明确诊断或高度怀疑为颅内生殖细胞瘤,初治不宜采用立体定向放射外科治疗作为单一治疗方法,一旦已经实施,应设法联合常规外照射放疗和/或化疗进行补救性治疗。对于复发病例,根据既往治疗情况,选用放化疗等治疗。

Patterns of Failure and Salvage Treatment for Recurrent Intracranial Germinoma after the Stereotactic Radiosurgery Therapy:A Single-Institution Experience

Objective To discuss the patterns of failure and salvage treatment rationality of the stereotaxic radiosurgery(SRS)as the initial therapy strategy on intracranial germinoma.Methods To retrospectively analyze the clinical materials of 17 cases which received the treatment of the SRS.13 patients were treated with SRS alone,and the remaining 4 patients treated with SRS following whole brain irradiation(WBI)or craniospinal irradiation(CSI).Results All the patients of 17 cases were admitted again from 3 months to 24 months after which had received SRS.After the initial treatment,13 patients were treated with SRS alone developed recurrences including local recurrences alone in 5,local recurrences and intracranial dissemination in 6,local recurrences and spinal dissemination in 1,and intracranial dissemination alone in 1.Another 4 patients developed local recurrences and intracranial/spinal dissemination in 3,and intracranial dissemination alone in 1.All the patients were received salvage chemotherapy,14 underwent salvage with CSI or WBI or whole ventricle irradiation(WVI)combined with or without boost radiation,3 refused radiotherapy and received chemotherapy alone.The calculated 10-year overall survival rate after salvage treatment was 76.5%.Conclusion SRS can't be regarded as the initial treatment for intracranial germinoma.If the patients received SRS,they should be follow WBI or CSI in time.For recurrence after SRS,radiotherapy combined with platinum-based chemotherapy appears to be effective.