Intracranial Germ Cell Tumors and Pineal Tumors: Suboptimal Treatment with Radiosurgery alone Report of Four Cases and Review of Literature

中樞神經生殖細胞瘤及松果體腫瘤：單獨使用放射手術治療之病例報告及文獻回顧

王駿瑋(Chun-Wei Wang) ； 王令瑋(Ling-Wei Wang) ； 潘宏基(Hung-Chi Pan) ； 鍾文裕(Wen-Yuh Chung) ； 劉康渡(Kang-Du Liu) ； 郭萬祐(Wan-Yuo Guo) ； 吳秀美(Hsiu-Mei Wu) ； 顔上惠(Sang-Hue Yen) ； 蕭正英(Cheng-Ying Shiau)

《放射治療與腫瘤學》 12卷4期 (2005/12) Pp. 301-312

https://doi.org/10.6316/TRO/200512(4)301

摘要

對於中樞神經生殖細胞瘤之治療目前仍無統一共識，從全腦脊髓照射或是局部病灶照射，到化學治療的使用與否目前仍有歧見。至今文獻上有數篇病例報告建議將放射手術應於用中樞神經生殖細胞瘤的治療上。而本篇文章提出四名臨床上診斷中樞神經胚細胞瘤(germinoma)的病例使用放射手術治療之結果。第一位25歲男性病患接受15Gy伽傌刀放射手術治療，治療後6個月發現有脊髓腔轉移，之後接受全腦脊髓照射，至今追蹤6年病況穩定但留有第四對腦神經功能受損的後遺症。第二位14歲男性病患，其病灶位於基底核，接受10Gy伽傌刀後拒絕接受後續安排的全腦室體外放射線治療，伽傌刀後7個月發現照野內復發，之後經體外放射線治療成功控制疾病，但留有輕微左側肢體無力的神經學後遺症。第三位30歲女性病患其病灶位於松果體，經10Gy伽傌刀治療後腫瘤大小仍無明顯改善，因此又接受第二次9.5Gy伽傌刀治療，至今兩年多追蹤無復發情況發生。第四位18歲男性病患其病灶位為松果體，接受15Gy伽傌刀治療，至今三年腫瘤控制仍穩定。經由上述四例的綜合結果來看，單獨使用放射手術並不適合當作中樞神經生殖細胞瘤的主要治療。

關鍵字

中樞神經胚細胞瘤 ； 顱內生殖細胞瘤 ； 松果體腫瘤 ； 放射手術

並列摘要

The therapeutic approaches to intracranial germ cell tumors (GCTs) vary from craniospinal irradiation (CSI) to focal irradiation with or without chemotherapy. There were several cases reports in favor of the application of radiosurgery in the management of intracranial GCTs. In this report, four cases of presumed germinomas treated with Gamma Knife radiosurgery (GKRS) were presented. The first patient, a 25 years old gentleman with presumed pineal germinoma, had spinal seeding at 6 months after 15 Gy of GKRS. After salvage CSI, 4th cranial nerve radiation injury developed. The second patient, a 14 years old boy with basal ganglion germinoma and elevated serum β-HCG, received a 10 Gy upfront GKRS boost but declined the scheduled periventricular irradiation. In-field local recurrence developed at 7 months after the GKRS. After salvage periventricular irradiation, the patient suffered from mild neurological deficit with poor left limb coordination. The third patient, a 30 years old lady with presumed pineal germinoma, had a poor response to therapeutic trial of 10 Gy GKRS. She was given a second course of 9.5 Gy GKRS. The fourth patient, an 18 years old gentleman with presumably pineal germinoma, had tumor control at 3 years after 15 Gy of GKRS. Based on the outcome of these 4 cases, radiosurgery alone is not recommended as the primary treatment for intracranial GCTs.

並列關鍵字

CNS germinoma ； Intracranial germ cell tumors ； Pineal tumors ； Radiosurgery