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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 investigate the clinical effect of preoperative chemotherapy in children with gonadal malignant germinomas. Methods A retrospective analysis of 20 cases of gonadal germ cell malignant germ cell tumor admitted to our hospital from March 2002 to March 2007 was performed with chemotherapy before operation. Scheme 1 was modified PEB: cisplatin (P) plus etoposide E) Plus Pingyangmycin (B), Scheme 2 VAC: Vincristin (V) plus actinomycin D (A) plus cyclophosphamide (C), the average chemotherapy for 16 weeks, after the end of chemotherapy for tumor resection Preoperative review of serum alpha-fetoprotein (AFP) levels compared with before chemotherapy, regular follow-up of children. Results Twenty patients underwent preoperative chemotherapy combined with surgical resection plus postoperative adjuvant chemotherapy. The surgical resection rate was 100% and the surgical procedure was smooth. The tumor volume of 14 patients after chemotherapy was reduced by more than 50% compared with that before chemotherapy, and the clinical effective rate was 70% 15 cases of children with AFP levels decreased significantly after chemotherapy, accounting for 75%; 15 cases were followed up for more than 2 years with no tumor, accounting for 75% of all children, of which 5 cases survived more than 5 years. Conclusion The malignant germ cell tumors of gonad proliferate infiltratively and invade the surrounding organs, which brings difficulty to surgical resection. Preoperative chemotherapy can reduce the tumor volume, reduce the intraoperative hemorrhage, improve the tumor resection rate and decrease the serum AFP Level, thereby improving the treatment effect, improve children’s prognosis, can be used as a routine treatment.