化学療法（carboplatin，etoposide，adriamycin，bleomycin併用）と放射線照射の併用が有効であった再発頭蓋内悪性胚細胞腫の1例

Successful Treatment with Combined Chemotherapy (carboplatin, etoposide, adriamycin, bleomycin) and Radiotherapy for Recurrent Intracranial Malignant Germ Cell Tumor:Case report

I．緒言

　Germ cell tumorの治療の問題点の一つは，組織像の多様性と，各々の組織像と組織構成により治療成績が異なることである．germinomaは極めて放射線感受性が高く，純型であれば完全治癒も期待できるが，純型ger—minomaとmixed germinomaはほぼ同数と報告されている^5）．従って組織診断を行わずにgerminomaと診断した場合は，放射線療法により一旦腫瘍が縮小しても再発し，germinoma以外の組織要素が主体を占め，治療に抵抗を示すことも少なくない．

　今回われわれは，尿崩症にて発症しAFP（alpha feto—protein）およびHCG（human chorionic gonadotropin）とも陰性で，鞍上部germinomaの診断の下に放射線療法を施行し腫瘍はほぼ消失したにも拘らず，6年後に局所再発と頸髄播種を示しAFP，HCG共に高値を示した1例を経験した．幸いにもcarboplatin，etoposide，adria—mycin，bleomycinの4者併用化学療法と，放射線療法の追加により完全寛解が得られたので，その経過を報告し，germ cell tumor治療の問題点について考察する．

We report a case of a patient with recurrent malig-nant germ cell tumor who was successfully treated with carboplatin combination followed by radiation therapy. A 13 year-old female presented with diabetes insipidus six years ago. From the homogeneous tumor intensity on CT scan and negative titer of AFP and HCG, we made a diagnosis of suprasellar germinoma, and treated her with radiation therapy (40Gy), which resulted in almost complete disappearance of the tumor. The tumor recurred six years later in the primary region and in the cervical spinal cord with elevated AFP titer (160ng/ ml) and HCG titer (404mIU/ml). She was treated with multi-agents chemotherapy consisting of carboplatin (450mg/m², day 1), etoposide (150mg/m², days 1-3), adriamycin (30mg/m², day 1), and bleomycin (20mg/ m², days 1 and 8), followed by radiation therapy to the whole brain (20Gy), the whole spine (30Gy) and the cervical spine (20Gy). The tumors completely dis-appeared. We discuss treatment failures of clinically dia-gnosed germinoma without histological verification, and effective aggressive chemotherapy for recurrent malignant germ cell tumors.