雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 23, Issue 1 （January 1995）

Neurological Surgery 脳神経外科 23巻1号（1995年1月発行）

Japanese English

症例

VAB−6療法が有効であった頭蓋内卵黄嚢腫の6歳男児例 A Case Report of a 6-Year-old Boy with Intracranial Yolk Sac Tumor Treated by VAB-6 Regimen 和田英男 ^1,3 , 久保実 ¹ , 和田泰三 ¹ , 上野康尚 ¹ , 堀田成紀 ¹ , 大木徹郎 ¹ , 宗本滋 ² , 黒田英一 ² , 田口博基 ² , 村松直樹 ² Hideo WADA ^1,3 , Minoru KUBO ¹ , Taizo WADA ¹ , Yasuhisa UENO ¹ , Seiki HORITA ¹ , Tetsurou OHKI ¹ , Shigeru MUNEMOTO ² , Eiichi KURODA ² , Hiroki TAGUHI ² , Naoki MURAMATSU ² ¹石川県立中央病院小児内科 ²石川県立中央病院脳神経外科 ³金沢大学医学部附属病院小児科 ¹Department of Pediatrics, Ishikawa Prefectural Central Hospital ²Department of Neurosurgery, Ishikawa Prefectural Central Hospital キーワード： Intracranial yolk sac tumor , Modified VAB−6 chemotherapy Keyword: Intracranial yolk sac tumor , Modified VAB−6 chemotherapy pp.65-68

発行日 1995年1月10日 Published Date 1995/1/10

DOI https://doi.org/10.11477/mf.1436900967

PDF(3570KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

I．はじめに

　本邦における小児の頭蓋内胚細胞腫瘍（Germ Cell Tumors，GCTs）は，小児脳腫瘍の約10％を占め，欧米に比較して数倍多いと言われている．その中でも胎児蛋白であるα—fetoprotein（AFP）を産生するYolk Sac Tumorは最も悪性の性格を示し，従来は放射線治療が第一選択として行われてきたが，予後不良で殆どが1年以内に再発している．

　しかし，近年小児の睾丸・卵巣領域のnonseminoma—tous GCTsに対してCisplatin（CDDP），Vinblastine（VBL），Bleomycin（BLM）を含むPVB療法^8），さらにこれら三剤にActinomycin D（AMD），Cyclophospha—mide（CPM）を加えたVAB−6療法^2,6）（Table 1）の有効性が報告され，頭蓋内GCTsに対しても試みられている^1,4,7,12）．

Several clinical trials have demonstrated that cispla-tin-based chemotherapy for primary intracranial germ-cell tumors is effective as a neoadjuvant chemotherapy.

In this report, we describe a 6-year-old boy, Down syndrome and Hirschsprung's disease with intracranial pure yolk sac tumor treated by combined chemother-apy with cisplatin, vinblastine, bleomycin and cy-clophosphamide (modified VAB-6 regimen). He had been admitted to our hospital because of intractable vomiting, and left facial nerve palsy since lmonth be-fore. An MRI revealed an enlarged mass, 4cm in dia-meter, in the left cerebello-pontine angle with uniforml enhancement by Gd-DTPA, and bilateral ventricular dilatation. He was found to have increased serum alpha-fetoprotein level (AFP 11, 786ng/ml), but not hu-man chorionic gonadotropin β-subunit. After a partial resection of the tumor, diagnosed as pure yolk sac tumor, and ventriculo-peritoneal shunt, three courses of combined chemotherapy with cisplatin, bleomycin, vinblastine and cyclophosphamide (modified VAB-6 therapy) were carried out. The serum AFP level re-turned to normal, and the tumor mass entirely dis-appeared (a complete response) on MRI after the second course of chemotherapy. However, cisplatin-induced vomiting and mild neutropenia and renal tubu-lar injury developed after the third course of che-motherapy. Irrespective of administration of recom-binant human G-CSF and broad spectrum antibiotics, he suffered from pneumonia and died of septic shock and multiple organ failure. Autopsy showed microsco-pic residual tumors.

The combination chemotherapy with cisplatin, bleomycin, vinblastine and cyclophosphamide is effective for initial treatment of childhood intracranial yolk sac tumor. It is necessary, however, to reevaluate the cis-platin dosage and treatment schedule in order to reduce such side effects as bone marrow suppression and renal damage.