诊断性化疗在颅内生殖细胞瘤诊治中的应用  

Application of diagnostic chemotherapy in the diagnosis and treatment of intracranial germinoma

作　　者：方陆雄[1] 徐书翔[1] 朱明华[1] 漆松涛[1] 

机构地区：[1]南方医科大学南方医院神经外科,广州510515

出　　处：《中华神经外科杂志》2013年第10期984-986,共3页Chinese Journal of Neurosurgery

摘　　要：目的探讨诊断性化疗诊治颅内生殖细胞瘤的可行性及临床意义。方法对13例血浆肿瘤标志物检测正常，临床表现高度提示可能为生殖细胞瘤，病理获取困难或风险较大的患者实施诊断性化疗。化疗采用顺铂＋依托泊甙标准剂量方案，仅实施1个疗程，结束后10～14d行CT或MRI复查。参考WHO实体瘤疗效评价标准判断化疗效果，并结合后期治疗的结果检验诊断性化疗的可靠性。结果完全缓解2例，部分缓解9例，无变化2例。完全缓解和部分缓解患者随后实施了放疗，治疗结果支持生殖细胞瘤诊断。2例诊断性化疗后无变化的患者，1例接受了手术，病理为胶质瘤Ⅱ级，另1例观察随访：半年后多次MRI复查证实为海绵状血管瘤。结论诊断性化疗具备区分生殖细胞瘤与非生殖细胞瘤的能力，对高度怀疑颅内生殖细胞瘤患者，可依靠其辅助确诊。Objective To explore and evaluate the feasibility and clinical significance of diagnostic chemotherapy in the diagnosis and treatment of intracranial germinoma. Methods Diagnostic chemotherapy was applied in 13 cases with germinoma related clinical manifestation and normal level of serum tumor marker, but difficulty or high risk in acquiring histopathologie sample. Only one course of standard eisplatin plus etoposide protocol was given, and CT or MRI was performed in 10-14 days after chemotherapy. The therapeutic effect was evaluated according to the WHO standard for chemotherapy of solid tumor. The reliability of diagnostic chemotherapy was also verified by long-term effect. Results 2 cases of complete response, 9 cases of partial response and 2 cases of no response were observed. The cases of complete response and partial response underwent radiotherapy in the following treatment, and the result supported the diagnosis of germinoma. One of the two no-response cases received surgery and was proved to be a grade-II glioma. The other one ease of no response underwent no further treatment, and 6-month followup MRI demonstrated a cavernoma. Conclusions Diagnostic chemotherapy could be applied to identify germinoma and non-germinoma, and to confirm the diagnosis in case of high possibility of germinoma.

关 键 词：生殖细胞瘤 诊断 化疗 中枢神经系统 

分 类 号：R739.4[医药卫生—肿瘤]