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目的 报告 30例原发颅内生殖细胞瘤治疗的远期疗效和探讨其治疗方法。方法 30例先经不同程度肿瘤切除手术后给予放射治疗 ,放射治疗采用常规分割外照射方法。 2 8例全脑预防照射后缩小照射野到肿瘤区追加放射至肿瘤足量 ;2例仅做肿瘤区放射治疗。 19例做了全脊髓预防照射。未做全脑预防和低剂量脑预防照射的 2例出现脑转移 (1例合并脊髓转移 )做再程放射治疗。结果 全部病例 5、10、15、19年生存率分别为 93.1%、87.6 %、87.6 %、6 8.2 %。临床症状缓解率为95 %。再程放射治疗的 2例中 1例生存超过 17年 ,1例现也已超过 10年。结论 颅内生殖细胞瘤争取手术治疗的贡献在于减小肿瘤体积并获得病理诊断和分流脑积水 ,放射治疗是治愈的有效方法。全脑预防照射作为必要治疗措施 ,脑预防剂量在 2 6～ 30Gy和肿瘤灶治疗量在 5 0～ 5 5Gy为宜。脊髓预防照射可因病情需要选择采用 ,不可作为常规方法。 14岁以下幼年在脑预防照射时要保护垂体 ,不做脊髓预防照射为好 ,对原发蝶鞍区肿瘤的放射治疗总量降低到 45Gy。
Objective To report the long-term efficacy and treatment of 30 cases of primary intracranial germ cell tumors. Methods Thirty patients were given radiotherapy after surgery with different degrees of tumor resection. Radiotherapy was performed with conventional method of external segmentation. Twenty-eight cases of total brain irradiation after the prevention of radiation to the tumor area to reduce the additional radiation to the tumor enough; 2 cases of radiation therapy only for the tumor area. Nineteen patients underwent total spinal cord prophylaxis. Two cases of brain metastasis (one case with spinal cord metastases) who did not do whole brain prevention and low-dose brain prophylaxis showed recurrent radiotherapy. Results The overall 5-, 10-, 15-, and 19-year survival rates were 93.1%, 87.6%, 87.6%, and 68.2%, respectively. The clinical remission rate was 95%. One of two cases of repeat radiotherapy survived for more than 17 years, and one case has now exceeded 10 years. Conclusion The contribution of intracranial germ cell tumor to surgical treatment is to reduce the tumor volume and obtain pathological diagnosis and shunt hydrocephalus. Radiotherapy is an effective method for cure. As a necessary treatment measure, total brain irradiation is recommended. The dose of brain prophylaxis is between 26 and 30 Gy and the therapeutic amount of tumor foci is between 50 and 55 Gy. Spinal cord prophylaxis can be selected because of the condition and cannot be used as a routine method. Under the age of 14 years, the pituitary should be protected during cerebral prophylaxis, and spinal cord prophylaxis should not be used. The total radiotherapy for primary sella tumors should be reduced to 45 Gy.