進行性精巣腫瘍に対する集学的治療の成績

Abstract

1)初期化学療法のみの57例中CRは24例, PRは33例, 再燃は8例, 長期生存(NED)は52例であった. 2)救済化学療法の16例中CRは1例, PRは12例, PDは3例, 再燃は3例, NEDは11例であった. 3)残存組織が壊死に達した24例のNEDは96%, 成熟奇形腫(6例)では100%に対して, 残存癌(13例)では54%で予後不良であった. 4)腫瘍マーカーが正常化した32例中8例に残存癌が認められたことから化学療法終了時に, 残存癌の有無を予測するのは困難で, 適切な時期の救済外科療法が重要である. 5)救済外科療法後の再発や, 手術不能例の難治性精巣腫瘍19例の治療成績は, 集学的治療にも拘わらずNEDが9例であった

Since 1980, 73 patients with advanced testicular cancer have been treated with chemotherapy and 43 patients received post-chemotherapy (salvage) surgery. The median age of all patients was 31 years old, ranging from 17 to 63 years. The histology of the primary testicular tumor was pure seminoma in 23 patients and non-seminoma in 50 patients. According to the Japan Urological Association classification, 38 patients were classified as stage II and 35 patients as stage III. As first-line chamotherapy, 52 patients were treated with PVB regimen (cisplatin, vinblastin, bleomycin), 16 patients with PEB (cisplatin, etoposide, bleomycin) and 5 patients with VAB-6 (vinblastine, actinomycin-D, bleomycin, cisplatin, cyclophosphamide). Thirty (41%) of the 73 patients achieved a complete response (CR) with chemotherapy alone and 63 (86%) achieved no evidence of disease (NED) with salvage treatment. As second-line chemotherapy, 16 patients were treated with PE (cisplatin, etoposide), or VIP (etoposide, ifosfamide, cisplatin) or VeIP (vinblastine, ifosfamide, cisplatin). One of the 16 patients achieved CR and 11 (69%) patients achieved NED. As salvage surgery, retroperitoneal lymphnode dissection (RPLND) was performed in 22 patients, RPLND with thoracotomy in 7 cases and thoracotomy alone in 4 cases. Necrosis was found in surgical specimens of 24 (56%) patients, mature teratoma in 6 (14%) and residual cancer in 13 (30%). Ninety-six percent and 100% of the patients with necrosis and mature teratoma survived with NED, respectively, but only 54% of the patients with residual carcinoma survived despite further treatment. Residual cancer was still found in 8 of the 32 (25%) marker normalized cases. Residual cancer could not reliably be predicted or discriminated from necrosis or mature teratoma by the prognostic criteria. Therefore, salvage surgery remains essential in the treatment of advanced testicular cancer.