頭蓋内胚細胞腫の診断・治療のupdate
胚細胞腫瘍は, 若年者に好発し, さまざまな組織型から構成される疾患群である. それぞれの組織型により, 摘出・放射線・化学療法の役割が異なるため, 標準治療の確立が困難である. 現在までに本邦や欧米で臨床試験が行われ, さまざまな方向から診断法の確立・治療の開発が行われてきた. 一方で, 2013年にDelphi法でのコンセンサス形成が行われ, 診断・治療に関してコンセンサスとなった事項と議論すべき事項が明確になった. 本稿では, これらの経緯と現状を踏まえ, 胚腫・非胚腫性胚細胞腫における診断・分類上・治療の問題点, 近年得られた知見について概説を加える....
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| Published in | 脳神経外科ジャーナル Vol. 31; no. 1; pp. 31 - 38 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人日本脳神経外科コングレス
01.01.2022
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0917-950X 2187-3100 |
| DOI | 10.7887/jcns.31.31 |
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| Abstract | 胚細胞腫瘍は, 若年者に好発し, さまざまな組織型から構成される疾患群である. それぞれの組織型により, 摘出・放射線・化学療法の役割が異なるため, 標準治療の確立が困難である. 現在までに本邦や欧米で臨床試験が行われ, さまざまな方向から診断法の確立・治療の開発が行われてきた. 一方で, 2013年にDelphi法でのコンセンサス形成が行われ, 診断・治療に関してコンセンサスとなった事項と議論すべき事項が明確になった. 本稿では, これらの経緯と現状を踏まえ, 胚腫・非胚腫性胚細胞腫における診断・分類上・治療の問題点, 近年得られた知見について概説を加える. |
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| AbstractList | 胚細胞腫瘍は, 若年者に好発し, さまざまな組織型から構成される疾患群である. それぞれの組織型により, 摘出・放射線・化学療法の役割が異なるため, 標準治療の確立が困難である. 現在までに本邦や欧米で臨床試験が行われ, さまざまな方向から診断法の確立・治療の開発が行われてきた. 一方で, 2013年にDelphi法でのコンセンサス形成が行われ, 診断・治療に関してコンセンサスとなった事項と議論すべき事項が明確になった. 本稿では, これらの経緯と現状を踏まえ, 胚腫・非胚腫性胚細胞腫における診断・分類上・治療の問題点, 近年得られた知見について概説を加える. |
| Author | 冨永, 悌二 金森, 政之 |
| Author_xml | – sequence: 1 fullname: 冨永, 悌二 organization: 東北大学大学院神経外科学分野 – sequence: 1 fullname: 金森, 政之 organization: 東北大学大学院神経外科学分野 |
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| ContentType | Journal Article |
| Copyright | 2022 日本脳神経外科コングレス |
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| DOI | 10.7887/jcns.31.31 |
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| References | 30) Yamasaki K, Okada K, Soejima T, Kosaka Y, Nagashima T, Hara J : Outcomes of local radiation and intensified combined intrathecal methotrexate and high-dose chemotherapy for intracranial germ cell tumors. J Pediatr Hematol Oncol 42 : e551-e557, 2020. 20) Phi JH, Kim SK, Lee J, Park CK, Kim IH, Ahn HS, Shin HY, Kim IO, Jung HW, Kim DG, Paek SH, Wang KC : The enigma of bifocal germ cell tumors in the suprasellar and pineal regions : synchronous lesions or metastasis? J Neurosurg Pediatr 11 : 107-114, 2013. 19) Rogers SJ, Mosleh-Shirazi MA, Saran FH : Radiotherapy of localised intracranial germinoma : time to sever historical ties? Lancet Oncol 6 : 509-519, 2005. 9) Fangusaro J, Wu S, MacDonald S, Murphy E, Shaw D, Bartels U, Khatua S, Souweidane M, Lu HM, Morris D, Panigrahy A, Onar-Thomas A, Fouladi M, Gajjar A, Dhall G : Phase Ⅱ trial of response-based radiation therapy for patients with localized CNS nongerminomatous germ cell tumors : a children's oncology group study. J Clin Oncol 37 : 3283-3290, 2019. 6) Chiba K, Aihara Y, Komori T, Kawamata T : Placental alkaline phosphatase in cerebrospinal fluid as a biomarker for optimizing surgical treatment strategies for pineal region germ cell tumors. Brain Tumor Pathol 37 : 60-68, 2020. 17) Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N, Seto T : Primary intracranial germ cell tumors : a clinical analysis of 153 histologically verified cases. J Neurosurg 86 : 446-455, 1997. 1) Aihara Y, Watanabe S, Amano K, Komatsu K, Chiba K, Imanaka K, Hori T, Ohba T, Dairoku H, Okada Y, Kubo O, Kawamata T : Placental alkaline phosphatase levels in cerebrospinal fluid can have a decisive role in the differential diagnosis of intracranial germ cell tumors. J Neurosurg 131 : 687-694, 2018. 21) Saito R, Kumabe T, Kanamori M, Sonoda Y, Watanabe M, Mugikura S, Takahashi S, Tominaga T : Early response to chemotherapy as an indicator for the management of germinoma-like tumors of the pineal and/or suprasellar regions. J Clin Neurosci 21 : 124-130, 2014. 3) Byun HK, Yoon HI, Cho J, Shim KW, Han JW, Lyu CJ, Kim DS, Suh CO : Optimization of intracranial germinoma treatment : radiotherapy alone with reduced volume and dose. Int J Radiat Oncol Biol Phys 108 : 657-666, 2020. 15) Kochi M, Itoyama Y, Shiraishi S, Kitamura I, Marubayashi T, Ushio Y : Successful treatment of intracranial nongerminomatous malignant germ cell tumors by administering neoadjuvant chemotherapy and radiotherapy before excision of residual tumors. J Neurosurg 99 : 106-114, 2003. 5) Calaminus G, Frappaz D, Kortmann RD, Krefeld B, Saran F, Pietsch T, Vasiljevic A, Garre ML, Ricardi U, Mann JR, Göbel U, Alapetite C, Murray MJ, Nicholson JC : Outcome of patients with intracranial non-germinomatous germ cell tumors-lessons from the SIOP-CNS-GCT-96 trial. Neuro Oncol 19 : 1661-1672, 2017. 23) Shinoda J, Yamada H, Sakai N, Ando T, Hirata T, Miwa Y : Placental alkaline phosphatase as a tumor marker for primary intracranial germinoma. J Neurosurg 68 : 710-720, 1988. 10) Goldman S, Bouffet E, Fisher PG, Allen JC, Robertson PL, Chuba PJ, Donahue B, Kretschmar CS, Zhou T, Buxton AB, Pollack IF : Phase Ⅱ Trial assessing the ability of neoadjuvant chemotherapy with or without second-look surgery to eliminate measurable disease for nongerminomatous germ cell Tumors : a children's oncology group study. J Clin Oncol 33 : 2464-2471, 2015. 25) Takami H, Perry A, Graffeo CS, Giannini C, Daniels DJ : Novel diagnostic methods and posttreatment clinical phenotypes among intracranial germ cell tumors. Neurosurgery 87 : 563-572, 2020. 16) 隈部俊宏, 日下康子, 城倉英史, 池田秀敏, 白根礼造, 吉本高志 : 化学療法単独で治療した頭蓋内胚腫の再発. No Shinkei Geka 30 : 935-942, 2002. 8) Duron L, Sadones F, Thiesse P, Cellier C, Alapetite C, Doz F, Frappaz D, Brisse HJ : Loco-regional extensions of central nervous system germ cell tumors : a retrospective radiological analysis of 100 patients. Neuroradiology 60 : 27-34, 2018. 27) The Committee of Brain Tumor Registry of Japan. Report of Brain Tumor Registry of Japan (2005-2008). Neurol Med Chir (Tokyo) 57 (Suppl) : 14-162, 2017. 26) Takano M, Kinoshita Y, Sugiyama K, Kolakshyapati M, Takayasu T, Yonezawa U, Taguchi A, Akiyama Y, Amatya VJ, Takeshima Y, Kurisu K, Yamasaki F : Detecting non-germinomatous germ cell tumor component by arterial spin labeling perfusion-weighted MR imaging in central nervous system germ cell tumor. Eur J Radiol 136 : 109523, 2021. 13) Kanamori M, Takami H, Yamaguchi S, Sasayama T, Yoshimoto K, Tominaga T, Inoue A, Ikeda N, Kambe A, Kumabe T, Matsuda M, Tanaka S, Natsumeda M, Matsuda KI, Nonaka M, Kurihara J, Yamaoka M, Kagawa N, Shinojima N, Negoto T, Nakahara Y, Arakawa Y, Hatazaki S, Shimizu H, Yoshino A, Abe H, Akimoto J, Kawanishi Y, Suzuki T, Natsume A, Nagane M, Akiyama Y, Keino D, Fukami T, Tomita T, Kanaya K, Tokuyama T, Izumoto S, Nakada M, Kuga D, Yamamoto S, Anei R, Uzuka T, Fukai J, Kijima N, Terashima K, Ichimura K, Nishikawa R : So-called bifocal tumors with diabetes insipidus and negative tumor markers : are they all germinoma? Neuro Oncol 23 : 295-303, 2021. 7) Denyer S, Bhimani AD, Patil SN, Mudreac A, Behbahani M, Mehta AI : Treatment and survival of primary intracranial germ cell tumors : a population-based study using SEER database. J Cancer Res Clin Oncol 146 : 671-685, 2020. 2) Balmaceda C, Heller G, Rosenblum M, Diez B, Villablanca JG, Kellie S, Maher P, Vlamis V, Walker RW, Leibel S, Finlay JL : Chemotherapy without irradiation―a novel approach for newly diagnosed CNS germ cell tumors : results of an international cooperative trial. The First International Central Nervous System Germ Cell Tumor Study. J Clin Oncol 14 : 2908-2915, 1996. 31) Yamasaki F, Kinoshita Y, Takayasu T, Usui S, Kolakshyapati M, Takano M, Tsuyuguchi S, Amatya VJ, Akiyama Y, Takeshima Y, Sugiyama K, Kurisu K : Proton Magnetic Resonance spectroscopy detection of high lipid levels and low apparent diffusion coefficient Is characteristic of germinomas. World Neurosurg 112 : e84-e94, 2018. 22) Sawamura Y, Kato T, Ikeda J, Murata J, Tada M, Shirato H : Teratomas of the central nervous system : treatment considerations based on 34 cases. J Neurosurg 89 : 728-737, 1998. 4) Calaminus G, Kortmann R, Worch J, Nicholson JC, Alapetite C, Garrè ML, Patte C, Ricardi U, Saran F, Frappaz D : SIOP CNS GCT 96 : final report of outcome of a prospective, multinational nonrandomized trial for children and adults with intracranial germinoma, comparing craniospinal irradiation alone with chemotherapy followed by focal primary site irradiation for patients with localized disease. Neuro Oncol 15 : 788-796, 2013. 29) Weiner HL, Finlay JL : Surgery in the management of primary intracranial germ cell tumors. Childs Nerv Syst 15 : 770-773, 1999. 14) Kanamori M, Takami H, Suzuki T, Tominaga T, Kurihara J, Tanaka S, Hatazaki S, Nagane M, Matsuda M, Yoshino A, Natsumeda M, Yamaoka M, Kagawa N, Akiyama Y, Fukai J, Negoto T, Shibahara I, Tanaka K, Inoue A, Mase M, Tomita T, Kuga D, Kijima N, Fukami T, Nakahara Y, Natsume A, Yoshimoto K, Keino D, Tokuyama T, Asano K, Ujifuku K, Abe H, Nakada M, Matsuda KI, Arakawa Y, Ikeda N, Narita Y, Shinojima N, Kambe A, Nonaka M, Izumoto S, Kawanishi Y, Kanaya K, Nomura S, Nakajima K, Yamamoto S, Terashima K, Ichimura K, Nishikawa R : Necessity for craniospinal irradiation of germinoma with positive cytology without spinal lesion on MR imaging―A controversy. Neurooncol Adv 3 : vdab086, 2021. 11) Kanamori M, Kumabe T, Saito R, Yamashita Y, Sonoda Y, Ariga H, Takai Y, Tominaga T : Optimal treatment strategy for intracranial germ cell tumors : a single institution analysis. J Neurosurg Pediatr 4 : 506-514, 2009. 12) Kanamori M, Kumabe T, Watanabe M, Chonan M, Saito R, Yamashita Y, Ogawa Y, Sonoda Y, Tominaga T : Indications for salvage surgery during treatment for intracranial germ cell tumors. J Neurooncol 138 : 601-607, 2018. 28) Watanabe S, Aihara Y, Kikuno A, Sato T, Komoda T, Kubo O, Amano K, Okada Y, Koyamaishi Y : A highly sensitive and specific chemiluminescent enzyme immunoassay for placental alkaline phosphatase in the cerebrospinal fluid of patients with intracranial germinomas. Pediatr Neurosurg 48 : 141-145, 2012. 18) Murray MJ, Bartels U, Nishikawa R, Fangusaro J, Matsutani M, Nicholson JC : Consensus on the management of intracranial germ-cell tumours. Lancet Oncol 16 : e470-e477, 2015. 24) Takami H, Fukuoka K, Fukushima S, Nakamura T, Mukasa A, Saito N, Yanagisawa T, Nakamura H, Sugiyama K, Kanamori M, Tominaga T, Maehara T, Nakada M, Kanemura Y, Asai A, Takeshima H, Hirose Y, Iuchi T, Nagane M, Yoshimoto K, Matsumura A, Kurozumi K, Nakase H, Sakai K, Tokuyama T, Shibui S, Nakazato Y, Narita Y, Nishikawa R, Matsutani M, Ichimura K : Integrated clinical, histopathological, and molecular data analysis of 190 central nervous system germ cell tumors from the iGCT Consortium. Neuro Oncol 21 : 1565-1577, 2019. |
| References_xml | – reference: 13) Kanamori M, Takami H, Yamaguchi S, Sasayama T, Yoshimoto K, Tominaga T, Inoue A, Ikeda N, Kambe A, Kumabe T, Matsuda M, Tanaka S, Natsumeda M, Matsuda KI, Nonaka M, Kurihara J, Yamaoka M, Kagawa N, Shinojima N, Negoto T, Nakahara Y, Arakawa Y, Hatazaki S, Shimizu H, Yoshino A, Abe H, Akimoto J, Kawanishi Y, Suzuki T, Natsume A, Nagane M, Akiyama Y, Keino D, Fukami T, Tomita T, Kanaya K, Tokuyama T, Izumoto S, Nakada M, Kuga D, Yamamoto S, Anei R, Uzuka T, Fukai J, Kijima N, Terashima K, Ichimura K, Nishikawa R : So-called bifocal tumors with diabetes insipidus and negative tumor markers : are they all germinoma? Neuro Oncol 23 : 295-303, 2021. – reference: 20) Phi JH, Kim SK, Lee J, Park CK, Kim IH, Ahn HS, Shin HY, Kim IO, Jung HW, Kim DG, Paek SH, Wang KC : The enigma of bifocal germ cell tumors in the suprasellar and pineal regions : synchronous lesions or metastasis? J Neurosurg Pediatr 11 : 107-114, 2013. – reference: 24) Takami H, Fukuoka K, Fukushima S, Nakamura T, Mukasa A, Saito N, Yanagisawa T, Nakamura H, Sugiyama K, Kanamori M, Tominaga T, Maehara T, Nakada M, Kanemura Y, Asai A, Takeshima H, Hirose Y, Iuchi T, Nagane M, Yoshimoto K, Matsumura A, Kurozumi K, Nakase H, Sakai K, Tokuyama T, Shibui S, Nakazato Y, Narita Y, Nishikawa R, Matsutani M, Ichimura K : Integrated clinical, histopathological, and molecular data analysis of 190 central nervous system germ cell tumors from the iGCT Consortium. Neuro Oncol 21 : 1565-1577, 2019. – reference: 25) Takami H, Perry A, Graffeo CS, Giannini C, Daniels DJ : Novel diagnostic methods and posttreatment clinical phenotypes among intracranial germ cell tumors. Neurosurgery 87 : 563-572, 2020. – reference: 12) Kanamori M, Kumabe T, Watanabe M, Chonan M, Saito R, Yamashita Y, Ogawa Y, Sonoda Y, Tominaga T : Indications for salvage surgery during treatment for intracranial germ cell tumors. J Neurooncol 138 : 601-607, 2018. – reference: 4) Calaminus G, Kortmann R, Worch J, Nicholson JC, Alapetite C, Garrè ML, Patte C, Ricardi U, Saran F, Frappaz D : SIOP CNS GCT 96 : final report of outcome of a prospective, multinational nonrandomized trial for children and adults with intracranial germinoma, comparing craniospinal irradiation alone with chemotherapy followed by focal primary site irradiation for patients with localized disease. Neuro Oncol 15 : 788-796, 2013. – reference: 9) Fangusaro J, Wu S, MacDonald S, Murphy E, Shaw D, Bartels U, Khatua S, Souweidane M, Lu HM, Morris D, Panigrahy A, Onar-Thomas A, Fouladi M, Gajjar A, Dhall G : Phase Ⅱ trial of response-based radiation therapy for patients with localized CNS nongerminomatous germ cell tumors : a children's oncology group study. J Clin Oncol 37 : 3283-3290, 2019. – reference: 3) Byun HK, Yoon HI, Cho J, Shim KW, Han JW, Lyu CJ, Kim DS, Suh CO : Optimization of intracranial germinoma treatment : radiotherapy alone with reduced volume and dose. Int J Radiat Oncol Biol Phys 108 : 657-666, 2020. – reference: 31) Yamasaki F, Kinoshita Y, Takayasu T, Usui S, Kolakshyapati M, Takano M, Tsuyuguchi S, Amatya VJ, Akiyama Y, Takeshima Y, Sugiyama K, Kurisu K : Proton Magnetic Resonance spectroscopy detection of high lipid levels and low apparent diffusion coefficient Is characteristic of germinomas. World Neurosurg 112 : e84-e94, 2018. – reference: 23) Shinoda J, Yamada H, Sakai N, Ando T, Hirata T, Miwa Y : Placental alkaline phosphatase as a tumor marker for primary intracranial germinoma. J Neurosurg 68 : 710-720, 1988. – reference: 28) Watanabe S, Aihara Y, Kikuno A, Sato T, Komoda T, Kubo O, Amano K, Okada Y, Koyamaishi Y : A highly sensitive and specific chemiluminescent enzyme immunoassay for placental alkaline phosphatase in the cerebrospinal fluid of patients with intracranial germinomas. Pediatr Neurosurg 48 : 141-145, 2012. – reference: 7) Denyer S, Bhimani AD, Patil SN, Mudreac A, Behbahani M, Mehta AI : Treatment and survival of primary intracranial germ cell tumors : a population-based study using SEER database. J Cancer Res Clin Oncol 146 : 671-685, 2020. – reference: 15) Kochi M, Itoyama Y, Shiraishi S, Kitamura I, Marubayashi T, Ushio Y : Successful treatment of intracranial nongerminomatous malignant germ cell tumors by administering neoadjuvant chemotherapy and radiotherapy before excision of residual tumors. J Neurosurg 99 : 106-114, 2003. – reference: 26) Takano M, Kinoshita Y, Sugiyama K, Kolakshyapati M, Takayasu T, Yonezawa U, Taguchi A, Akiyama Y, Amatya VJ, Takeshima Y, Kurisu K, Yamasaki F : Detecting non-germinomatous germ cell tumor component by arterial spin labeling perfusion-weighted MR imaging in central nervous system germ cell tumor. Eur J Radiol 136 : 109523, 2021. – reference: 16) 隈部俊宏, 日下康子, 城倉英史, 池田秀敏, 白根礼造, 吉本高志 : 化学療法単独で治療した頭蓋内胚腫の再発. No Shinkei Geka 30 : 935-942, 2002. – reference: 17) Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N, Seto T : Primary intracranial germ cell tumors : a clinical analysis of 153 histologically verified cases. J Neurosurg 86 : 446-455, 1997. – reference: 18) Murray MJ, Bartels U, Nishikawa R, Fangusaro J, Matsutani M, Nicholson JC : Consensus on the management of intracranial germ-cell tumours. Lancet Oncol 16 : e470-e477, 2015. – reference: 5) Calaminus G, Frappaz D, Kortmann RD, Krefeld B, Saran F, Pietsch T, Vasiljevic A, Garre ML, Ricardi U, Mann JR, Göbel U, Alapetite C, Murray MJ, Nicholson JC : Outcome of patients with intracranial non-germinomatous germ cell tumors-lessons from the SIOP-CNS-GCT-96 trial. Neuro Oncol 19 : 1661-1672, 2017. – reference: 14) Kanamori M, Takami H, Suzuki T, Tominaga T, Kurihara J, Tanaka S, Hatazaki S, Nagane M, Matsuda M, Yoshino A, Natsumeda M, Yamaoka M, Kagawa N, Akiyama Y, Fukai J, Negoto T, Shibahara I, Tanaka K, Inoue A, Mase M, Tomita T, Kuga D, Kijima N, Fukami T, Nakahara Y, Natsume A, Yoshimoto K, Keino D, Tokuyama T, Asano K, Ujifuku K, Abe H, Nakada M, Matsuda KI, Arakawa Y, Ikeda N, Narita Y, Shinojima N, Kambe A, Nonaka M, Izumoto S, Kawanishi Y, Kanaya K, Nomura S, Nakajima K, Yamamoto S, Terashima K, Ichimura K, Nishikawa R : Necessity for craniospinal irradiation of germinoma with positive cytology without spinal lesion on MR imaging―A controversy. Neurooncol Adv 3 : vdab086, 2021. – reference: 8) Duron L, Sadones F, Thiesse P, Cellier C, Alapetite C, Doz F, Frappaz D, Brisse HJ : Loco-regional extensions of central nervous system germ cell tumors : a retrospective radiological analysis of 100 patients. Neuroradiology 60 : 27-34, 2018. – reference: 1) Aihara Y, Watanabe S, Amano K, Komatsu K, Chiba K, Imanaka K, Hori T, Ohba T, Dairoku H, Okada Y, Kubo O, Kawamata T : Placental alkaline phosphatase levels in cerebrospinal fluid can have a decisive role in the differential diagnosis of intracranial germ cell tumors. J Neurosurg 131 : 687-694, 2018. – reference: 27) The Committee of Brain Tumor Registry of Japan. Report of Brain Tumor Registry of Japan (2005-2008). Neurol Med Chir (Tokyo) 57 (Suppl) : 14-162, 2017. – reference: 6) Chiba K, Aihara Y, Komori T, Kawamata T : Placental alkaline phosphatase in cerebrospinal fluid as a biomarker for optimizing surgical treatment strategies for pineal region germ cell tumors. Brain Tumor Pathol 37 : 60-68, 2020. – reference: 30) Yamasaki K, Okada K, Soejima T, Kosaka Y, Nagashima T, Hara J : Outcomes of local radiation and intensified combined intrathecal methotrexate and high-dose chemotherapy for intracranial germ cell tumors. J Pediatr Hematol Oncol 42 : e551-e557, 2020. – reference: 29) Weiner HL, Finlay JL : Surgery in the management of primary intracranial germ cell tumors. Childs Nerv Syst 15 : 770-773, 1999. – reference: 22) Sawamura Y, Kato T, Ikeda J, Murata J, Tada M, Shirato H : Teratomas of the central nervous system : treatment considerations based on 34 cases. J Neurosurg 89 : 728-737, 1998. – reference: 19) Rogers SJ, Mosleh-Shirazi MA, Saran FH : Radiotherapy of localised intracranial germinoma : time to sever historical ties? Lancet Oncol 6 : 509-519, 2005. – reference: 10) Goldman S, Bouffet E, Fisher PG, Allen JC, Robertson PL, Chuba PJ, Donahue B, Kretschmar CS, Zhou T, Buxton AB, Pollack IF : Phase Ⅱ Trial assessing the ability of neoadjuvant chemotherapy with or without second-look surgery to eliminate measurable disease for nongerminomatous germ cell Tumors : a children's oncology group study. J Clin Oncol 33 : 2464-2471, 2015. – reference: 2) Balmaceda C, Heller G, Rosenblum M, Diez B, Villablanca JG, Kellie S, Maher P, Vlamis V, Walker RW, Leibel S, Finlay JL : Chemotherapy without irradiation―a novel approach for newly diagnosed CNS germ cell tumors : results of an international cooperative trial. The First International Central Nervous System Germ Cell Tumor Study. J Clin Oncol 14 : 2908-2915, 1996. – reference: 11) Kanamori M, Kumabe T, Saito R, Yamashita Y, Sonoda Y, Ariga H, Takai Y, Tominaga T : Optimal treatment strategy for intracranial germ cell tumors : a single institution analysis. J Neurosurg Pediatr 4 : 506-514, 2009. – reference: 21) Saito R, Kumabe T, Kanamori M, Sonoda Y, Watanabe M, Mugikura S, Takahashi S, Tominaga T : Early response to chemotherapy as an indicator for the management of germinoma-like tumors of the pineal and/or suprasellar regions. J Clin Neurosci 21 : 124-130, 2014. |
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| Snippet | 胚細胞腫瘍は, 若年者に好発し, さまざまな組織型から構成される疾患群である. それぞれの組織型により, 摘出・放射線・化学療法の役割が異なるため, 標準治療の確立が困... |
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| Title | 頭蓋内胚細胞腫の診断・治療のupdate |
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