Craniopharyngiomaの治療—Bleomycinの効果について

THERAPEUTIC EXPERIENCE WITH BLEOMYCIN IN CRANIOPHARYNGIOMA

Ｉ．緒言

　Craniopharyngiomaは良性腫瘍でありながら，予後調査をみると，以外に成績はよくない。それは諸家の指摘する如く，視床下部，下垂体に近接する局在的特徴のためであろう。われわれの教室では，5年生存率は28.6％である^19）。

　近年，microsurgery^21）が本腫瘍の手術に用いられその症例が増加しつつあるが，従来の手術法では，視床下部などの機能不全を恐れて全摘を行なわなかつたり，逆に全摘を目指して術後重篤な視床下部の機能不全を起して症例を失うに至ることなどが，好成績を挙げられない原因であろう。Matson等^11）は，初回手術時の全摘出および，術前，術後の内分泌検査と，ホルモン補充の施行を推奨している。

It has been reported that Bleomycin (BLM), which was found and developed by Umezawa et al., is effective on squamous cell carcinoma. In considera-tion of effectiveness of BLM to epithelial tumors, we administered it to 16 patients with craniopha-ryngioma, who were not radically operated on. Of 16 craniopharyngioma cases, BLM was effective in 10, not yet evaluated in 4 and ineffective in 2, whooperated on 2 years ago and did not show any progressive symptoms after the operation.

BLM was employed preoperatively in 4 cases among whom 2 patients died of cardiovascular col-lapse, probably due to hypothalamic destruction, after the 2nd and 4th operation.

The visual disturbance, the visual field defect, the disturbance of conciousness and the paralysis were mainly improved by administration of BLM. The endocrinological symptoms, however were not improved. Optic symptoms, being easy to observe, were taken as an indicator for the evaluation of the effect.

We had the cases with recurrence, which were administered BLM followed by reoperation. The specimens taken during the 1st operation andones during the 2nd operation, were examined. There were some histological differences between them. In the specimens of 2 cases taken by the 2nd operation, the appearance of the vesicles and the pyknotic nuclei were found in a certain amount of cells of the basal cell layer. Another case showed the newly formed calcification. These histological findings may suggest the results of BLM.

BLM showed clinically the effect not only to adamantinomatous typed cases, but to squamous cell typed cases.

BLM, ingeneral, seems to have more effect on rapidly progressive cases than on slowly progressive ones.