“难治性”睾丸非精原细胞瘤的治疗经验

THE TREATMENT OF POOR-RISK PATIENTS WITH NONSEMINOM MATOUS TESTCULAR GERM CELL TUMOR(NSGCT)

广泛转移且肿瘤负荷大的晚期睾丸非精原细胞瘤病例治疗效果仍然欠佳,被视为难治性病例,其有效治疗方法亟待研究。 本文分析我院1980—1988年20例难治性睾丸非精原细胞瘤的治疗结果并探讨提高疗效的可能方法化疗方案为PVB-D或PVB-E(DDP、VCR,BLMA 5和ACTD或VP-16)。化疗效果为CR25％;PR65％。有19例被随访13—53个月,中数随访时间27个月,无瘤生存5例;带瘤生存并继续治疗中2例;其余12例死于肿瘤,总生存率36.7％。化疗的主要毒副反应为骨髓抑制、脱发、恶心和呕吐。而心、肝、肾、肺和神经系统副反应较轻,无因化疗毒性死亡者。治疗结果显示提高疗效的主要关键是:(1)DDP剂量是疗效的关键,剂量不足,影响疗效;(2)初治者较曾经放疗或/和化疗无效或复发者效果好;(3)化疗期间除了充分水化利尿之外,用3％盐水作DDP的溶剂将减轻DDP的肾毒性。

Dissemindated 20 NSGTCT Patients with heavy Tumor burden were treated with PVB-D of PVB-E(DDP, VCR, BLM-A5 Plus ACTD or VP-16) chemotherapy regimen between 1980 . and 1988 . The chemotheraqy response was CR 25%, PR65%, 19 of 20 patients were followed up for 13 to 53 months, the median follow up duration was 27 months. 5 patients are alive with disease -free, 2 patients alive with bisease , the remaining 12 patients died of cancer, total survival reate was 36.7%.Major side effects of chemotherapy were myelosuppression , alopecia, nausea and vomiting. Renal toxicity , neurotoxicity and lungs toicity was mild , no treatment related death was encountered.Our data showed that previously untreated patients have better response that previous treated. Also closed correlation of the response and dosage of DDP was founa, compromi ised DDP dosage usually resulted in poor response . In addition. 3 % NaCl solution used as a solvent of DDP in addition to adequatate hydration could diminish renal toxicity during DDP chemotherapy.