颅内原发生殖细胞瘤的放射治疗研究

目的 报告57例原发颅内生殖细胞瘤无期治疗效果和生存质量，探讨最佳治疗方法。方法 30例行手术后放射治疗；27例行单纯放射治疗。53例全脑预防照射，其中51例肿瘤区追加足剂量；4例仅做肿瘤局部放射而未给任何中枢神经区预防。全脊髓预防放射34例而未做脊髓预防23例。4例放疗后1－4年因出现中枢神经再肿瘤灶接受了再程放疗。结果全部病人5、10、15、19年生存率是89．1％、87．0％、80．0％、66．7％，手术＋放疗30例与单纯放疗27例之间生存率对比无差异（P＞0．05）。病人临床症状缓解率95％。卡氏评分法对比疗前后生存质量均数差（P＜0．001）。再程放疗4例生存时间超过2、7、10、17年。疗后远期，15岁以下14例（11例原发肿瘤位蝶鞍区）生殖器官发育能力受到明显影响，其因与幼年垂体受一定剂量照射直接有关（P＜0．01）。结论 颅内原发生殖细胞争取手术的目的在于肿瘤减体以及获得病理诊断和分流服积水。放射治疗是达到治愈目的的有效方法。全脑预防放射应作为常规措施，脑预防剂量：26Gy－30Gy；肿瘤治疗量：50Gy左右。脊髓预防照射不可作为常规。提议对15岁以下患者行全脑预防照射时要保护垂体避免照射和不做脊髓预防照射，对原发蝶鞍区的肿瘤放射总剂量减少到45Gy-40Gy。对于疗后再发肿瘤灶给予合理再程放疗仍有较好效果。

AN INVESTIGATION ON THE RADIOTHERAPY OF PRIMARY INTRACRANIAL GERMINOMA

ve 57 patients with primary intracranial germinoma were treated with radiotherapy and the long-term results and quality of life were investigated as well. Methods 30 cases were received radiation therapy after operation; 27 cases received simple radiation therapy. 53 patients received whole brain prophylactic radiation, of 51 with shrinking field to the local tumors site were irradiated complete doses; other 2 cases received whole brain radiation only without add radiation to local tumors and spinal cord irradiation. Results The 5 ~ , 10 ~ , 15 ~ , 19 ~ year survival rates of all patients were 89. 1%, 87.0%, 80.0%,66.7% respectively. There were no significant difference between the two groups of operation + radiation therapy and radiation therapy alone in survival rates (P > 0.05) . The remission rate of 57 patients was 95% .The survival time of 4 patients with re-course radiotherapy was 2,7,10,17 years respectively. The quality of life before and after treatment was measured by karnofsky evaluation method and showed significant difference (P < 0. 001). The genital organ development and fertility have beendistracted in 14 patients (primary tumor of 11 patients in sella turcica region } less than 15 years old because of the glandula pituifaria accepted fairly radiation doses in juvenile (P < 0.001). Conclusions The surgical operation makes to decrease tumors volume and shuiting hydrocrania and getting a pathologic diagnosis. The radiation therapy is excellent method to cure primary intracranial germinoma. Prophylactic irradiation in whole brain with an appropriate doses of 26Gy - 30Gy necessary. 50Gy ~ 55Gy of treating doses to the local tumors site is ought to be a routine program but not for prophylactic spinal cord axis irradiation. The later is not suitable for the patients whose age is less than 15 years old . The tumor doses may be decreased about to 45Gy ~ 40Gy for primary tumors in sella turcica region. A good curative effect can be got by re-course radiation therapy in the patients with recurrence tumor .