睾丸腫瘍の脳転移に対する治療法について

Abstract

Four patients with non-seminomatous testicular tumor who already had brain metastasis were treated with combination chemotherapy. Three patients had received craniotomy in an effort to remove the metastatic lesion and intracranial hematoma. Two of them who were treated with PVB chemotherapy, which was effective against pulmonary and retroperitoneal metastasis but not against the brain metastatic lesions, died within 3 months; the other patient is receiving intense postcraniotomy chemotherapy using Cisplatin and large doses of Methotrexate administered with the Leucovorin rescue method which has shown a remarkable response against the brain metastasis of choriocarcinoma. The remaining patient has been receiving VAB VI protocol for 3 months. The metastatic lesion in the temporal lobe of his brain may consolidate through calcification, similar to the calcified change observed in the retroperitoneal lymph-node after chemotherapy. We discuss potential ways to induce improved therapeutic effects against brain metastasis of the non-seminomatous testicular tumor: It may be difficult to achieve an effective drug concentration level in the tissue immediately adjacent to the intracerebral tumor, because of the blood brain barrier. As induction therapy, a large dose of Cisplatinum (230 mg/body) or Methotrexate (10 g/body) was effective in attaining an effective drug concentration level in the tissue adjacent to tumor. Prior to the stem cell assay of the brain metastatic tumor, 1, 100 mg Cisplatinum and 1, 700 mg VP 16 were administered for treatment. The results of the stem cell assay in vitro showed a resistance to Cisplatinum and VP 16. Routine brain CT scanning is useful for detecting a metastatic lesion in its development. If detected, multidisciplinary chemotherapy should be performed.(ABSTRACT TRUNCATED AT 250 WORDS)