摘要
目的探讨生殖腺外恶性生殖细胞瘤患儿进行术前化疗的临床效果。方法回顾性分析2002年3月-2007年3月本院收治的生殖腺外恶性生殖细胞瘤患儿20例,术前均予以化疗,方案1为改良PEB:顺铂(P)加依托泊苷(E)加平阳霉素(B),方案2为VAC:长春新碱(V)加放线菌素D(A)加环磷酰胺(C),平均化疗16周,化疗结束后行肿瘤切除术,术前复查血清甲胎蛋白(AFP)水平与化疗前对比,术后对患儿定期随访。结果20例患儿均接受术前化疗加手术切除加术后辅助化疗,手术切除率100%,手术过程顺利;14例化疗后肿瘤体积与化疗前对比缩小超过50%,临床有效率为70%;15例患儿化疗后AFP水平明显降低,占75%;术后随访15例患儿无瘤生存超过2 a,占全部患儿75%,其中5例存活超过5 a。结论生殖腺外恶性生殖细胞瘤呈浸润性生长,侵犯周围器官,给手术切除带来难度,对患儿给予术前化疗,可缩小肿瘤体积,减少术中出血,明显提高肿瘤切除率,降低血清AFP水平,从而提高治疗效果,改善患儿预后,可作为常规治疗方法。
Objective To explore the effect of preoperative chemotherapy for children with malignant extragonadial germinoma. Methods Twenty patients with malignant extrogonadal germinoma had been treated with preoperative chemotherapy from Mar. 2003 to Mar. 2007. Pro- tocol 1 of chemotherapy was to improve PEB：（ cisplatin plus etoposide plus bleomycin A5 ） ;Protocol 2 was VAC （vincristine plus actinomycin D plus c yclophosphamide） the average time span of the chemotherapy was 16 weeks. Upon completion of chemotherapy,tumor resection was performed. The content of alpha fetoprotein （AFP） was determined before operation and compared with the content before chemotherapy. Re- gular follow - up procedure was taken after operation. Results All 20 patients received chemotherapy and underwent operation. The removal rate of resection operation was 100% ,the process of operation was smooth. The volume of tumors in 14 patients decreased over 50% compared with those before chenmtherapy. The response rate was 70%. The content of AFP decreased significantly in 15 patients（75% ）. Fifteen patients had been living without tumor for up to 2 years,for 5 cases the survival time went beyond 5 years. Conclusions Malignant extrogonadal ger- minoma in children grow infihratively,bring detrimental effects to neighboring organs,and bring obstacles to resection operation. Chemotherapy for children with malignant extragonadal germinoma before operation can reduce volume of tumor and bleeding during operation,raise the re- sectability rate and lower the content of AFP. it will enhance the effectiveness of operation and improve prognosis. Therefore,it can be used as a conventional clinical method.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2009年第22期1761-1763,共3页
Journal of Applied Clinical Pediatrics
