低剂量诊断性放疗联合化疗在诊治颅内生殖细胞肿瘤中的价值  

Significance of diagnostic low-dose radiotherapy plus chemotherapy in the treatment of intracranial germ cell tumors without biopsy confirmation

作　　者：黄立敏[1] 雷竹[1] 曹雪[1] 骆雯[1] 廖加群[1] 吴海霞[1] 杨洁[1] 邱晓光[2] HUANG Limin;LEI Zhu;CAO Xue;LUO Wen;LIAO Jiaqun;WU Haixia;YANG Jie;QIU Xiaoguang(Department of Oncology, Guizhou Provincial People’s Hospital, Guiyang 550002, Guizhou Province, China;Department of Radiotherapy, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China)

机构地区：[1]贵州省人民医院肿瘤科,贵州贵阳550002 [2]首都医科大学附属北京天坛医院放疗科,北京100050

出　　处：《中国癌症杂志》2018年第4期270-275,共6页China Oncology

基　　金：贵阳市科技局项目([20141001]62号)

摘　　要：背景与目的:颅内生殖细胞肿瘤(intracranial germ cell tumors)经积极放化疗常可获得令人满意的局部控制率和生存率,然而对部分无法取得病理诊断的颅内生殖细胞肿瘤的治疗,研究者们至今无法达成一致意见。该研究探讨低剂量诊断性放疗联合化疗在诊治颅内生殖细胞肿瘤的可行性及临床意义。方法:该研究分析了贵州省人民医院及北京天坛医院收治的28例(16例男性,12例女性,中位年龄14.5岁)高度怀疑为颅内生殖细胞肿瘤的患者。患者血浆和(或)脑脊液人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-HCG)和甲胎蛋白(α-fetoprotein,AFP)均为阴性,头颅MRI诊断提示鞍区和(或)松果体区呈典型生殖细胞肿瘤影像特征,临床表现高度提示可能为生殖细胞瘤(germinoma)。这些患者因无法通过手术及立体定向活检明确病理诊断,或患者本身不同意手术或活检,因此我们建议实施诊断性低剂量放疗联合化疗方案,诊断性放疗剂量为3.4 Gy,1.7 Gy/2次。经低剂量诊断性放疗后行MRI复查。随后根据MRI复查结果采用以下治疗:⑴影像学为进展(progression disease,PD)或稳定(stable disease,SD),建议手术治疗。⑵影像学达完全缓解(complete response,CR)或部分缓解(partial release,PR),再予以2个周期化疗,顺铂+足叶乙甙(DDP+VP16)方案2个周期,化疗后再次行MRI复查,如果患者影像学检测结果显示达CR,随即按生殖细胞瘤进行调强放疗(intensity-modulated radiation therapy,IMRT)及三维适形放疗(three-dimensional conformal radiotherapy,3D-CRT)。放疗方案根据患者情况进行选择:(1)局部放疗;(2)全脑全脊髓+局部加量放疗;(3)全脑+局部加量放疗(松果体区病变总剂量小于等于50.4 Gy;鞍区病变总剂量小于等于41.0 Gy)。⑶经低剂量诊断性放疗联合化疗后行MRI复查,如果患者影像学仍未达CR,建议患者立即接受手术治疗。参考WHO实体瘤疗效评价标准判断放化疗�Background and purpose： The intracranial germ cell tumors always sensitive to radiotherapy and chemotherapy. However, in certain cases, definitive diagnosis before treatment is not conceivable due to the absence of pathological biopsy examination. Therefore, a therapeutic consensus on dealing with these patients remains to be established. The aim of this study was to evaluate the clinical significance and effectiveness of the diagnostic lowdose radiotherapy plus chemotherapy in intracranial germ cell tumors. Methods： There were 28 patients（12 male patients, 16 female patients, medium age 14.5 years） enrolled in this study. They had normal levels of α-fetoprotein（AFP） and β-human chorionic gonadotropin（β-HCG）. Magnetic resonance imaging（MRI） showed typical images of intracranial germ cell tumors at suprasellar and pineal gland regions. Clinical examination also strongly supported the intracranial germ cell tumors diagnosis. We used diagnostic radiotherapy combined with chemotherapy for these patients because stereotactic or surgical biopsy was excluded or refused. These patients received an initial phase of low-dose diagnostic radiotherapy（3.4 Gy/1.7 Gy/2 F）, then MRI was performed. The following treatment depended on the MRI results： ⑴ For the patients showing stable disease（SD）, surgery was recommended. ⑵ For those showing complete remission（CR） or partial remission（PR）, chemotherapy（VP16＋DDP regime） was given for 2 weeks. The rest of the patients showing CR received further intensity-modulated radiation therapy（IMRT） or three-dimensional conformal radiotherapy（3D-CRT）. The treatment varied accordingly with local irradiation, or whole brain irradiation plus whole ventricular irradiation then boost, or whole brain irradiation with local intensitymodulated irradiation（total doses≤50.4 Gy at pineal gland region; ≤41 Gy at sellar region）. ⑶ If the patients failed to achieve CR after chemotherapy, surgery was recommended. Results： One patient show

关 键 词：颅内生殖细胞肿瘤 生殖细胞瘤 诊断性放疗 化疗 

分 类 号：R739.41[医药卫生—肿瘤]