頭蓋内germ cell tumorの治療成績 : 特に再発例,脊髄転移例の検討

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Fifty-seven cases of primary intracranial germ cell tumors seen at the Hokkaido University Hospital from 1962 to 1980 were reviewed with special reference to local recurrence and spinal metastasis. The 57 tumors consisted of 47 geminomas (15 histologically verified and 32 histologically non-verified), 4 teratomas, and 6 teratoid tumors. This series comprised 49 males and 8 females, with ages ranging from 5 to 41 years (mean 18.1 years). Tumors were mainly treated with conservative therapy (cerebrospinal fluid shunting and radiotherapy) and only 11 tumors were treated with direct surgical removal. The 1-year survival rate of 47 cases of germinoma was 89%, 5 year survival 82%, and 10 year survival 76%; whereas the 5-year survival rate of teratomas and teratoid tumors was 44%. In teratomas, radiotherapy was not effective and long-term survival was obtained after surgical removal. Of the 15 fatalities, four died of tumor recurrence and two died of spinal metastases. Seven (12.3%) of the 57 patients had tumor recurrence. Of the seven patients, the recurrence incidence was four teratomas and teratoid tumors compared with three germinomas. Another seven patients (12.3%) had spinal metastases; of these, six had germinomas. Spinal metastasis developed within six months of the initial treatment. These patients were treated with laminectomy and irradiation to the spinal axis after the metastases developed. Three can accomplish self-care. Differential diagnosis of intracranial germ cell tumors was possible by CT, CSF cytology, and measurement of alpha-fetoprotein and human chorionic gondotropin without biopsy. A plan of management was proposed based on pathological features: Radiation therapy with or without shunting operation should be the primary treatment for germinomas. Moderate doses of irradiation (4,500-5,000 rads) would be adequate to control tumor in germinomas. Prophylactic irradiation of the whole spinal axis is necessary for certain types of germinomas. Direct operation should be chosen in teratomas and teratoid tumors. Postoperative radiotherapy and chemotherapy are necessary for the treatment of teratoid tumors.
日本脳神経外科学会の論文
1983-06-15

頭蓋内germ cell tumorの治療成績 : 特に再発例,脊髄転移例の検討

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