单周期新辅助化疗在颅内分泌型生殖细胞肿瘤治疗中的应用

The application of single-cycle neoadjuvant chemotherapy in the treatment of intracranial secreting germ cell tumor

目的初步探讨单周期新辅助化疗在颅内分泌型生殖细胞肿瘤综合治疗中的应用价值。方法回顾性分析2010年1月至2016年12月南方医科大学南方医院神经外科收治的42例血浆生殖细胞肿瘤标志物增高的颅内生殖细胞肿瘤患者的临床资料。治疗先给予1个周期的EP方案（顺铂＋足叶乙甙）化疗，然后依据疗效的不同分为两组，手术组：包含化疗后病变稳定或进展的患者，给予手术切除肿瘤，术后辅以化、放疗；继续化疗组：包含化疗后完全缓解或部分缓解的患者，进行继续化疗，随后放疗。结果42例患者均按计划完成新辅助化疗，症状减轻或缓解40例，无明显好转2例。手术组22例患者中，肿瘤全切除21例，次全切除1例。术后病理：混合性肿瘤11例，畸胎瘤8例，绒毛膜癌2例，卵黄囊瘤1例。术后无一例死亡或致残，治疗完成后均无肿瘤残留。继续化疗组20例患者治疗后的血浆生殖细胞肿瘤标志物均正常，但4例有病灶残留。42例患者中，34例获得随访，随访时间为6～72个月，平均（25．6±4．3）个月，其中死亡2例，复发2例，其余患者病情稳定，血浆生殖细胞肿瘤标志物正常。结论颅内分泌型生殖细胞肿瘤可采用单周期新辅助化疗进行分层，并依据分层结果进行相应的治疗。单周期新辅助化疗在提高手术安全性的同时，兼顾了患者手术的耐受性。

Objective To investigate the clinical significance of single-cycle neoadjuvant chemotherapy in the treatment of intracranial secreting germ cell tumor. Methods From January 2010 to December 2016, 42 patients with intracranial germ cell tumor and elevated serum markers admitted to Department of Neurosurgery, Nanfang Hospital, Southern Medical University were enrolled into this retrospective study. Patients were first treated with one cycle of EP （ etoposide and cisplatin） regimen and then divided into two groups according to their chemotherapy outcome. Group I included patients with nonremission or progression after chemotherapy, and then surgery, postoperative chemotherapy and radiotherapy were arranged. Group Ⅱ included patients with complete remission or partial remission after chemotherapy, and chemotherapy was then continued and followed by radiotherapy. Results A total of 42 patients completed the neoadjuvant chemotherapy according to the plan. Among them, improvement or relief was reported in 40 cases and no obvious improvement in 2. Of the 22 patients in the operation group, total tumor resection was performed in 21 cases and subtotal resection in 1. Postoperative pathology revealed that there were 11 cases of mixed tumor, 8 cases of teratoma, 2 cases of choriocarcinoma and 1 case of yolk sac tumor. No patients died or developed disability after treatment. No tumor residues were observed. Group Ⅱ included 20 cases. The serum markers of those patients were within normal limit after treatment and tumor residues were observed in 4 cases. Totally, 34 cases were followed up for 6 - 72 months with an average of 25.6 ± 4.3 months. There were 2 cases of death and 2 cases of recurrence. The other 30 cases remained stable with normal serum levels of tumor markers. Conclusions For intracranial secreted germ cell tumors, single-cycle neoadjuvant chemotherapy can be used for stratification, and the corresponding treatment should be arranged based on this stratification. In conclusion, although single-cycle neoadjuvant improves the safety of operation, the patient＇s surgical tolerance should be taken into account at the same time.