進行精巣腫瘍患者に対する後腹膜リンパ節郭清術

Abstract

1)非セミノーマstage 2Aに対しては郭清術あるいは化学療法のどちらを先に行っても治療成績の面では良好な結果がえられるが, 郭清術による腫瘍細胞の播種防止という観点からすれば化学療法を先行させた方がよい。2)非セミノーマでは化学療法後のPR例の残存腫瘍に腫瘍細胞が高率に残存しており, 郭清術を適応する必要がある。しかしCRなら郭清術を行わなくてもよいという結論はえられなかった。3)セミノーマでは化学療法(あるいは放射線療法)後の残存腫瘍が3cm未満あるいは縮小率が約80%以上であれば, 腫瘍細胞が存在する率は非常に低く郭清術を行う必要はない

We examined the indication for retroperitoneal lymph node dissection (RPLND) for 30 patients with advanced testicular tumor and made the following conclusion. The sequence of RPLND and primary chemotherapy made no difference in the therapeutic effect for patients with stage II A non-seminomatous germ cell tumor (NSGCT). However, we thought it better to administer primary chemotherapy prior to RPLND to prevent dissemination of tumor cells. Viable tumor cells often remained in retroperitoneal residual tumors even after chemotherapy in the patients with NSGCT advanced beyond stage II B. Therefore, RPLND seemed to be necessary if residual retroperitoneal tumors were found after the chemotherapy. In patients with seminoma, RPLND did not seem to be necessary if the residual tumor was less than 3 cm in diameter or the reduction rate of the retroperitoneal tumor was more than 80% after the initial therapy (chemotherapy or irradiation therapy.