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中華民國泌尿科醫學會雜誌

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篇名 The Experience of Combination of Chemotherapy and Surgery in Treatment of Advanced Nonseminomatous Germ Cell Tumor of the Testis
卷期 10:1
並列篇名 化學治療合併手術切除對侵犯性非精原細胞睪丸癌的治療經驗
作者 高育琳楊啟瑞程千里歐宴泉賀昊中石宏文
頁次 001-006
關鍵字 非精原細胞睪丸癌化學治療後腹腔淋巴切除術nonseminomatous germ cell tumorchemotherapyretroperitoneal lymph node dissectionTSCI
出刊日期 199903

中文摘要

以cisplatin 為主的化學治療對生殖細胞癌深具療效。四個療程的引入性化學治療合併完整的後腹腔淋巴腺切除術是目前侵犯性非精原細胞睪丸癌的標準治療方式。在這十年內,共有十位病人在我們科裡接受治療。七位病人(7/10,70%)接受以bleomycin + etoposide + cisplatin 組成的引入性化學治療可達到完全緩解,即是血清腫瘤標記回復正常值以內。爾後六個血清腫瘤標記值正常病人接受後腹腔淋巴腺切除術及殘餘腫瘤清除,他們的病理標本為壞死或纖維化者佔33 %,畸胎瘤佔17%及惡性腫瘤佔50 %,病理標本中有惡性腫瘤的病人都再追加兩個療程的化學治療。這六個病人都沒有復發現象,且都存活,其平均存活時間為六年。至於其他化學治療反應不佳及不接受切除術的病人都於兩年內死亡。所以我們認為以bleomycin + etoposide + cisplatin 組成之第一線化學治療對侵犯性非精原細胞睪丸癌可達成令人滿意的緩解,並且它的毒性是容易處理的,而且化學治療後的後腹腔淋巴腺切除術是絕對必要的,如此才可達到長期的病人存活。

英文摘要

Cisplatin-based chemotherapy is highly effctive in treating germ cell tumors. Inductive chemotherapy and postchemotherapy retroperitoneal lymph node dissection (RPLND) have become the prefered standard treatment in advanced nonseminomatous germ cell tumor of the testis. Ten patients with advanced nonseminomatous germ cell tumor were treated with cisplatin-based chemotherapy. Four cycles BEP (bleomycin plus etoposide plus cisplatin) or EP (etoposide plus cisplatin) chemotherapy yielded 70% complete remission rate in advanced nonseminomatuos germ cell tumor of the testis. Six of these patients underwent RPLND and simultaneous resection of the postchemotherapy residual masses. The histologic findings of resected residual masses were necrosis/fibrosis in 2 (33%) patients, mature teratoma in 1 (17%) patient, and viable tumor in 3 (50%) patients. Patients with viable tumors received additional cycles of chemotherapy. These 6 patients had no evidence of disease after a mean follow-up time of 72 mo. The other 4 patients who were refractory to inductive chemotherapy (n=3) or afraid of surgery (n=1) all died of the disease within 2 yrs. BEP chemotherapy is effective as first-line inductive treatment in advanced nonseminoma-tous germ cell tumors, and the toxicity is easily manageable. Postchemotherapy retroperitoneal lymph node dissection with resection of residual masses is mandatory and can foster long-term disease-free survival.

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