Improvement of Long-term Results with Neoadjuvant Chemotherapy and Radiotherapy for Central Nervous System Germinoma
Improvement of Long-term Results with Neoadjuvant Chemotherapy and Radiotherapy for Central Nervous System Germinoma
复制标题
DOI：
10.1016/j.wneu.2015.06.029
复制
发表时间：
2015-09-01
影响因子：
2
通讯作者：
Matsumura, Akira
中科院分区：
文献类型：
--
作者：
Takano, Shingo;Yamamoto, Tetsuya;Matsumura, Akira
目的：方法：回顾性分析1980 ~ 2009年38例中枢神经系统生殖细胞瘤患者的临床资料，分析新辅助化疗和放疗在中枢神经系统生殖细胞瘤治疗中的作用。方法：确诊时中位年龄16.5岁，随访时间128.3个月。治疗方法为单纯放疗或辅助性铂类化疗，随后进行剂量减少的局部放疗。7例患者在治疗开始后12.9-133.9个月进展，1例在治疗开始后89.3个月死于疾病（1980-1988，n=5），全脑局部照射; B组（1989-2002），化疗加或不加减少照射剂量; C组（2003-2009年，n=17）：新辅助化疗3个疗程后，局部完全缓解者加用全室照射30.6戈伊，其余加用局部加强照射19.8戈伊。复发7例，均为B组。A、C组无进展生存期明显长于B组（P< 0.001）。在A-C组中分别有2例（40%）、6例（37.5%）和0例病例观察到Karnofsky体力状态下降。C组取得良好疗效的主要原因可能是新辅助化疗联合全脑室放疗和神经内镜检查的引入，尤其是对松果体病变，从而大大缩短了从诊断到首次治疗的时间。化疗后进行全心室放疗，有或没有局部加强，并且神经内镜的使用在生殖细胞瘤患者中导致良好的疾病控制而没有晚期并发症。
OBJECTIVE: To evaluate the role of neoadjuvant chemotherapy and radiotherapy in the treatment of central nervous system germinomas in 38 patients who received definitive treatment and were followed-up >5 years between 1980 and 2009.METHODS: The median age at diagnosis and follow-up period were 16.5 years and 128.3 months, respectively. Treatment was irradiation alone or adjuvant platinum-based chemotherapy followed by reduced-dose local irradiation. Seven patients progressed at 12.9-133.9 months and 1 died of disease 89.3 months after therapy initiation.RESULTS: The treatment strategies were divided into 3 groups: group A (1980-1988, n=5), whole brain with local irradiation; group B (1989-2002, n=16), chemotherapy with or without reduced irradiation dose; and group C (2003-2009, n=17): neoadjuvant chemotherapy (3 courses) followed by 30.6 Gy of whole ventricle irradiation for patients with localized complete response, and additional local boost of 19.8 Gy for others. There were 7 recurrent cases, all in group B. The progression-free survival was significantly longer in groups A and C versus group B (P< 0.001). Decreased Karnofsky performance status was observed in 2 (40%), 6 (37.5%), and 0 cases in groups A-C, respectively. The main reasons for the good results in group C might be the neoadjuvant chemotherapy with whole ventricle radiotherapy and introduction of neuroendoscopy, especially for pineal lesions, resulting in a substantial reduction of time from the diagnosis to first treatment.CONCLUSIONS: Chemotherapy followed by whole ventricle radiotherapy, with or without local boost, and with use of neuroendoscopy results in good disease control without late complications in patients with germinomas.