联合化疗和放射治疗颅内生殖细胞瘤的远期疗效观察

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24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,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（25－35Gy)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以治疗颅内生殖细胞瘤的最佳方案。

Long-term effect of chemotherapy combined with radiotherapy in treatment of intracranial germinoma: report of 39 cases

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.