精巣胚細胞腫瘍52例(53腫瘍)の治療成績

Abstract

1)過去13年間に精巣胚細胞腫瘍52例53腫瘍を治療した.Stage Iはおもに経過観察, 進行例はVAB-6療法3コースで治療し, PR例には追加療法を行った. 2)Stage Iの経過観察とした31腫瘍中6腫瘍に再発を認め, seminoma 23腫瘍中2腫瘍, NSGCT 8腫瘍中4腫瘍とNSGCTに高率であった.NSGCT中における脈管浸潤及び胎児性癌の存在が, 再発の危険因子と考えられた. 3)Seminoma stage II及びIII4腫瘍, 再発例2腫瘍計6腫瘍に施行したVAB-6療法の結果は, CR 3腫瘍, PR 3腫瘍で集学的治療により全例生存中である.NSGCTのstage II及びIII 11腫瘍, 再発例4腫瘍計15腫瘍においてもCR 8腫瘍, PR 7腫瘍で追加治療により全例一旦はCRを獲得した.1例の治療関連死を除き14例が癌なし生存中と良好な結果を得た

Between August 1983 and April 1996, 53 testicular germ cell tumors in 52 patients were treated at Toranomon Hospital. The average age of the patients was 36.1 years (range 21-89). The affected side was the right side in 24, left in 27 and bilateral in 1 case. Of the 53 tumors 34 (64.2%) were seminoma and 19 (35.8%) were non-seminomatous germ cell tumor (NSGCT). High ligation orchiectomy was performed in all cases. Of 29 stage I seminomas, post-operative adjuvant radiotherapy was performed in 6 cases prior to 1991. None of these tumors recurred. Two cases of relapses (8.7%) were found among the 23 stage I seminomas followed by surveillance. Of 8 stage I NSGCTs followed by surveillance, 4 (50.0%) tumors which contained embryonal carcinoma element and vascular invasion relapsed within 12 months after orchiectomy. A case of stage IIA seminoma was treated successfully by irradiation. Seven cases of stage II (3 seminomas and 4 NSGCTs) and 8 cases of stage III (1 seminoma and 7 NSGCTs) as well as cases of 6 stage I patients who developed relapse during surveillance were treated by VAB-6 chemotherapy. Of these 21 cases, 11 (52.4%) achieved complete response (CR) and 10 (47.6%) partial response (PR). Salvage surgery and/or additional chemotherapy was successful to bring the 10 PR cases into CR condition. One NSGCT patient, however, died of electrolyte imbalance during the maintenance chemotherapy for disease progression after achieving CR. All 34 patients with seminomas and 18 of the 19 with NSGCTs were alive without evidence of disease after a mean follow up period of 61.1 months (range 4-150 months).