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題名:Radiotherapy for Intracranial Germinoma: Tr eatment Modalities and Clinical Outcome     (18點)
放射線治療對於顱內生殖細胞瘤之臨床結果與治療方式分析
著者:Yu-Jen Wang(王裕仁) ;Feng-Ming Hsu(許峯銘) ;Yu-Hsuan Chen(陳育瑄) ;Chiao-Ling Tsai(蔡巧琳) ;Wan-Yu Chen(陳婉瑜) ;Jason Chia-Hsien Cheng(成佳憲) ;Sung-Hsin Kuo(郭頌鑫)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:生殖細胞瘤 ; 放射線治療 ; 化學治療 ; 全腦脊髓照射 ; 全腦室 ; Germinoma ; Radiotherapy ; Chemotherapy ; Craniospinal irradiation ; Whole-ventricle
刊名:Therapeutic Radiology and Oncology
頁碼:111-119
語言:英語
摘要: 中文摘要PDF ; 英文摘要PDF

目的:我們用回溯性分析顱內生殖細胞瘤的臨床病理特徵,治療方式包括單純放射線治療(RT),及引導式化學治療併放射線治療(CRT)及其臨床預後。
研究方法與材料:於2006年到2012年,總共收錄20位經病理組織確認,並在本院接受治療並有追蹤資料的顱內生殖細胞瘤的病人。其中16位病人接受合併化學治療與放射線治療(CRT),4位病人接受單純放射線治療(RT)。對於接受CRT的病人,他們先接受1到5個療程的引導式化學治療後,接受局部放射線治療(全腦室或是腫瘤區域)或者是全腦脊髓照射。放射線治療之劑量與照野大小因腫瘤位置,腫瘤對於化學治療之反應和脊髓受侵犯之狀態而定。在20位病人中,有13位病人採用三度空間放射線治療技術進行治療,其他7位接受全腦脊髓照射的病人,則採用螺旋刀治療技術。
結果:本研究包括18位男性與2位女性,年齡中位數為14歲,範圍為7至29歲。追蹤時間平均中位數為34個月,其3年的無疾病存活率為90%,而整體存活率為100%。對於單純接受放射線治療的病人,全腦脊髓照射劑量為30.6格雷(Gy),每日照射1.8格雷,若無腦脊髓照射時,全腦室及腦下腺神經部照射劑量為30格雷,每日照射2格雷,再針對腫瘤區域加強劑量到中位數劑量50格雷(46.5-50.4格雷)。而對於接受化學治療及放療的病人,全腦脊髓照射劑量中位數為24格雷(21.6-30.6格雷),每日接受1.5至1.8格雷,之後再針對腫瘤區域加強劑量到中位劑量45格雷(24-50.4格雷)。單純接受放射線治療的病人中沒有復發的情況,然而2位接受化放療但沒有接受全腦脊髓照射的病人則發生脊椎區域復發。
結論:我們的研究成果顯示對於顱內生殖細胞瘤而言,不論病患腦脊髓液是否測得β-HCG,前導式化療搭配較少劑量及較小照射範圍的放射線治療,皆可達到良好的疾病控制與預後。
Purpose : We retrospectively analyzed the clinicopathologic features and treatment modalities, including radiotherapy (RT) alone and induction chemotherapy followed by RT (CRT), and the clinical outcomes of intracranial germinoma.
Methods and Materials : A total of 20 patients diagnosed with tissue-confirmed intracranial germinoma between 2006 and 2012 and available follow-up data were included in this study. Sixteen patients underwent CRT and 4 underwent RT alone. CRT involved one to five cycles of upfront chemotherapy followed by limited-field (whole ventricle plus primary tumor boost) or extended-field RT (craniospinal irradiation [CSI] followed by limited-field), for which the RT field and dose depended on the tumor location, response to chemotherapy, and metastatic status. Among them, 13 patients received limited or extended-field RT with 3-dimensional (3D) conformal radiotherapy (3D-CRT), and 7 patients received CSI accompanied by helical tomotherapy.
Results : This study consisted of 18 male and 2 female patients, with a median age of 14 years (7–29 y). After a median follow-up of 34 months, the 3-year disease-free survival rate and overall survival (OS) rate were 90% and 100%, respectively. For the RT alone group, the CSI was delivered with a tumor dose of 30.6 Gy in fractions of 1.8 Gy/d, whole-ventricle and neurohypophysis involved administering 30 Gy in fractions of 2 Gy/d if no CSI was used. Finally, the tumor was boosted to receive a total median dose of 50 Gy (46.5–50.4 Gy), whereas for the CRT group, the entire brain and/or spine received a median of 24 Gy (21.6–30.6 Gy) in fractions of 1.5–1.8 Gy/d, and the tumor was boosted to a total median dose of 45 Gy (24–50.4 Gy). No recurrences developed in patients treated using extended RT; however, 2 patients treated with CRT, but not with CSI, developed spinal relapse.
Conclusion : Our results indicate that induction chemotherapy accompanied by dosereduced and volume-reduced RT resulted in effective disease control and prognosis for intracranial germinoma, including β-HCG secreting germinoma.


    

本卷期目次
Therapeutic Radiology and Oncology
Image-Guided Stereotactic Radiosurgery Usi ng Volumetric Modulated Arc Therapy for Arteriovenous Malformation of the Brain: Experiences of a Single Institution/ Chia-Chun HuangTung-Hao ChangChu-Ping PiLi-Chung HungTsai-Wei Chou
Radiotherapy for Intracranial Germinoma: Tr eatment Modalities and Clinical Outcome/ Yu-Jen WangFeng-Ming HsuYu-Hsuan ChenChiao-Ling TsaiWan-Yu ChenJason Chia-Hsien ChengSung-Hsin Kuo
惡性間皮細胞瘤應用銳速刀與強度調控放射治療計劃之比較/ 賴鵬安劉芳慧賴耿光葉啟源
電腦斷層治療機照野寬度與螺距參數設定對治療計畫的影響:假體實驗/ 吳任弘葉恬綺溫嘉綺王雱儀蕭仟翊許仲賢
ADJUVANT RADIOTHERAPY FOR RECURRENT MUCOEPIDERMOID CARCINOMA OF THE ORBIT: A CASE REPORT AND REVIEW OF LITERATURE/ Nan-Tsung WangChing-Jung WuShih-Hung Huang
PRIMARY SMALL CELL CARCINOMA OF THE URETER - A CASE REPORT AND REVIEW OF THE LITERATURE/ Yu-An ChienTung-Hao ChangMu-Tai LiuChu-Ping PiChia-Chun HuangLi-Chung HungTsai-Wei Chou
Hemoglobin Level during Chemoradiation Th erapy Predicts Treatment Outcome in Nasopharyngeal Cancer/ Bing-Jie ShenPei-Wei Shueng
A RETROSPECTIVE COMPARISON OF TREATMENT RESULTS AMONG GBM PATIENTS TREATED WITH DIFFERENT RADIOTHERAPY PROTOCOLS/ Shang-Yu ChouChun-Chieh HuangYu-Jie HuangFu-Min FangEng-Yen HuangChong-Jong WangHui-Chun ChenYu-Ming WangHsuan-Chih Hsu
 
   
 
   

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