1
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Vuong HG, Ngo TNM, Dunn IF. Incidence, Prognostic Factors, and Survival Trend in Pineal Gland Tumors: A Population-Based Analysis. Front Oncol 2021; 11:780173. [PMID: 34869031 PMCID: PMC8639690 DOI: 10.3389/fonc.2021.780173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Pineal gland tumors are exceedingly rare and account for 0.4-1.0% of brain neoplasms. Their rarity has confounded a clear understanding of the prognostic factors and standards of care for these neoplasms. In this study, we aimed to investigate the incidence, prognostic indicators, and survival trend of tumors emanating from the pineal gland. Methods We accessed the Surveillance, Epidemiology, End Results (SEER) Program for pineal gland tumors from 1975-2016. A multivariate Cox regression model was used to investigate the impact of clinicopathological parameters on all-cause mortality. For survival trend analysis, we employed the Kaplan Meier curve and pairwise comparisons to examine the trend. Results We found 1,792 and 310,003 pineal gland and brain neoplasms during 1975-2016 resulting in an incidence of 0.6%. In the multivariate Cox proportional hazards model, older age, male gender, non-germ cell tumor, and receipt of chemotherapy were significantly associated with poor survival (p < 0.001). The extent of resection and radiotherapy administration did not produce survival advantages. Our result also highlighted an increased survival of pineal gland tumors over the years. Conclusion Our study investigated the prognostic factors that influenced survival in patients with pineal gland tumors. Chemotherapy use adversely affected patient outcomes and should be considered carefully in specific circumstances to avoid its harmful effects. These findings provide important evidence to improve current standards of care for this rare group of tumors. The survival of pineal tumors has improved over time reflecting improvements in current practice.
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Affiliation(s)
- Huy Gia Vuong
- Department of Neurosurgery, Oklahoma University Health Sciences Center, Oklahoma City, OK, United States.,Department of Pathology, Oklahoma University Health Sciences Center, Oklahoma City, OK, United States
| | - Tam N M Ngo
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Ian F Dunn
- Department of Neurosurgery, Oklahoma University Health Sciences Center, Oklahoma City, OK, United States
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2
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Molecular Pathology and Targeted Therapies for Personalized Management of Central Nervous System Germinoma. J Pers Med 2021; 11:jpm11070661. [PMID: 34357128 PMCID: PMC8306901 DOI: 10.3390/jpm11070661] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/05/2021] [Accepted: 07/10/2021] [Indexed: 12/19/2022] Open
Abstract
Intracranial germinomas are rare tumours, usually affecting male paediatric patients. They frequently develop in the pineal and suprasellar regions, causing endocrinological disturbances, visual deficits, and increased intracranial pressure. The diagnosis is established on magnetic resonance imaging (MRI), serum and cerebrospinal fluid (CSF) markers, and tumour stereotactic biopsy. Imaging techniques, such as susceptibility-weighted imaging (SWI), T2* (T2-star) gradient echo (GRE) or arterial spin labelling based perfusion-weighted MRI (ASL-PWI) facilitate the diagnosis. Germinomas are highly radiosensitive tumours, with survival rates >90% in the context of chemoradiotherapy. However, patients with resistant disease have limited therapeutic options and poor survival. The aim of this review is to highlight the genetic, epigenetic, and immunologic features, which could provide the basis for targeted therapy. Intracranial germinomas present genetic and epigenetic alterations (chromosomal aberrations, KIT, MAPK and PI3K pathways mutations, DNA hypomethylation, miRNA dysregulation) that may represent targets for therapy. Tyrosine kinase and mTOR inhibitors warrant further investigation in these cases. Immune markers, PD-1 (programmed cell death protein 1) and PD-L1 (programmed death-ligand 1), are expressed in germinomas, representing potential targets for immune checkpoint inhibitors. Resistant cases should benefit from a personalized management: genetic and immunological testing and enrolment in trials evaluating targeted therapies in intracranial germinomas.
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Kutin MA, Fomichev DV, Shkarubo AN, Chernov IV, Sharipov OI, Andreev DN, Ismailov DB, Mikhailov NI, Kobyakov GL, Trunin YY, Astafyeva LI, Abdilatipov AA, Poddubsky AA, Kalinin PL. Endoscopic Transsphenoidal Approach in Treatment of Germinomas of the Chiasmosellar Region. Asian J Neurosurg 2019; 14:1190-1195. [PMID: 31903361 PMCID: PMC6896623 DOI: 10.4103/ajns.ajns_156_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Introduction Germinogenic central nervous system (CNS) tumors represent a heterogeneous group of tumors, constituting approximately 0.4% of all primary brain tumors. Removal of the tumor has no prognostic value. In "pure" primary germinomas of the CNS, the alpha-fetoprotein and human chorionic gonadotropin levels are within normal limits, and no specific biochemical tumor markers currently exist for this tumor type, making histological verification crucial for the choice of treatment tactics. When the tumor is located in the chiasmosellar region, one of the possible verification methods is endoscopic endonasal transsphenoidal biopsy. Objective The main objective of the study is to demonstrate the feasibility and safety of endoscopic transsphenoidal approach for histological verification of primary germinomas of the CNS with chiasmosellar localization. Materials and Methods The current study includes 13 patients with "pure" germinomas of the chiasmosellar region who underwent endoscopic endonasal surgical interventions with subsequent treatment according to the "Germinoma 2008" protocol. Results The extent of surgical intervention ranged from biopsy (4) to partial (5) and total (4) removal of the tumor. In all cases, histological verification of the diagnosis was achieved and none of the patients presented with cerebrospinal fluid leaks and/or meningitis in the postoperative period, allowing to evaluate endoscopic intervention in our patient series as safe and effective. Two out of 13 patients were lost to follow-up. Conclusion The endoscopic endonasal approach for histological verification and removal of chiasmosellar region germinomas is safe, and in some cases, less traumatic for the patient than transcranial and transventricular approaches.
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Affiliation(s)
- Maxim Alexandrovich Kutin
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | | | - Alexey Nikolaevich Shkarubo
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Ilia Valerievich Chernov
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Oleg Ildarovich Sharipov
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Dmitry Nikolaevich Andreev
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | | | - Nikita Igorevich Mikhailov
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Grigoriy Lvovich Kobyakov
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Yuriy Yurievich Trunin
- Department of Radiology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Ludmila Igorevna Astafyeva
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | | | - Artem Andreevich Poddubsky
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
| | - Pavel Lvovich Kalinin
- Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia
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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 2019; 131:687-694. [PMID: 30265190 DOI: 10.3171/2018.3.jns172520] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/06/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Placental alkaline phosphatase (PLAP) in CSF can provide a very high diagnostic value in cases of intracranial germ cell tumors (GCTs), especially in pure germinomas, to the level of not requiring histological confirmation. Unlike other tumor markers, reliable data analysis with respect to the diagnostic value of PLAP serum or CSF levels has not been available until now. This is the first systematic and comprehensive study examining the diagnostic value of CSF PLAP in patients with intracranial GCTs. METHODS From 2004 to 2014, 74 patients (average age 19.6 ± 10.6 years) with intracranial GCTs were evaluated using PLAP from their CSF and histological samples. Chemiluminescent enzyme immunoassay was utilized to measure CSF PLAP in the following tumor sites: pineal (n = 32), pituitary stalk, suprasellar (n = 16), basal ganglia (n = 15), intraventricular (n = 9), and cerebellar (n = 5) regions. In addition to classifying GCT cases, all patients underwent tumor biopsy for correlation with tumor marker data. RESULTS PLAP in combination with other tumor markers resulted in extremely high sensitivity and specificity of the diagnostic value of intracranial GCTs. Intracranial GCT cases were classified into 1) germinomas, both "pure" and syncytiotrophoblastic giant cell types (n = 38); 2) nongerminomatous GCTs, choriocarcinomas (n = 9) and teratomas (n = 4); and 3) nongerminomas, other kinds of tumors (n = 23). Consequently, all patients received chemoradiation therapy based on elevation of PLAP and the histopathological results. It was also speculated that the level of PLAP could show the amount of intracranial germ cell components of a GCT. PLAP was 100% upregulated in all intracranial germinoma cases. The absence of CSF PLAP proved that the tumor was not a germinoma. CONCLUSIONS The current study is the first systematic and comprehensive examination of the diagnostic value of the tumor marker PLAP in pediatric patients with intracranial GCT. Using the level of PLAP in CSF, we were able to detect the instances of intracranial germinoma with very high reliability, equivalent to a pathological diagnosis.
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Affiliation(s)
- Yasuo Aihara
- 1Department of Neurosurgery, Tokyo Women's Medical University, Tokyo
| | - Sinichiro Watanabe
- 2Division of Internal Medicine and Clinical Laboratory Medicine, Minamisenju Hospital, Tokyo; and
| | - Kosaku Amano
- 1Department of Neurosurgery, Tokyo Women's Medical University, Tokyo
| | - Kana Komatsu
- 1Department of Neurosurgery, Tokyo Women's Medical University, Tokyo
| | - Kentaro Chiba
- 1Department of Neurosurgery, Tokyo Women's Medical University, Tokyo
| | - Kosuke Imanaka
- 1Department of Neurosurgery, Tokyo Women's Medical University, Tokyo
| | - Tomokatsu Hori
- 1Department of Neurosurgery, Tokyo Women's Medical University, Tokyo
| | - Takashi Ohba
- 2Division of Internal Medicine and Clinical Laboratory Medicine, Minamisenju Hospital, Tokyo; and
| | - Hitoshi Dairoku
- 3Faculty of Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Yoshikazu Okada
- 1Department of Neurosurgery, Tokyo Women's Medical University, Tokyo
| | - Osami Kubo
- 1Department of Neurosurgery, Tokyo Women's Medical University, Tokyo
| | - Takakazu Kawamata
- 1Department of Neurosurgery, Tokyo Women's Medical University, Tokyo
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Borde TD, Arimappamagan A, Srinivas D, Narasinga Rao KVL, Devi BI, Somanna S, Santosh V. Intracranial Germ Cell Tumors: Spectrum of Disease in an Indian Cohort and Management Strategies. J Neurosci Rural Pract 2019; 9:291-297. [PMID: 30069081 PMCID: PMC6050793 DOI: 10.4103/jnrp.jnrp_86_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Germ cell tumors (GCTs) represent approximately 3% of primary pediatric brain tumors in the West, whereas in Asia, they constitute between 8% and 15% of pediatric brain tumors. Methods: We retrospectively studied all patients with intracranial GCT managed at our institute from January 1998 to December 2013. The clinical data and radiological data were analyzed. Results: Forty-eight patients with intracranial GCT including 36 males and 16 females formed the cohort. The proportion of GCT in our study was 0.29%. The mean age was 16.5 ± 2.5 years. Germinomas constituted 56.3% and nongerminomatous GCTs constituted 43.7% of all the tumors. The most common location was posterior third ventricle (58.3%) followed by suprasellar (22.9%). Histopathological diagnosis was obtained in almost all patients (96%). Surgical procedures included tumor decompression (71.7%), stereotactic biopsy (13%), and endoscopic third ventriculostomy and biopsy (15%). Patient's age, location of the tumor, and histology did not influence the survival. Women with GCTs had poorer survival when compared to men. Conclusions: The present study documented a lower hospital-based incidence of GCT in Indian cohort. A multidisciplinary approach including surgical strategy based on location, appropriate radiation planning, and chemotherapy is needed for effective treatment and improved outcomes.
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Affiliation(s)
- Tushar Deepak Borde
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Arivazhagan Arimappamagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - K V L Narasinga Rao
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - B Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sampath Somanna
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vani Santosh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Wildeman ME, Shepard MJ, Oldfield EH, Lopes MBS. Central Nervous System Germinomas Express Programmed Death Ligand 1. J Neuropathol Exp Neurol 2019; 77:312-316. [PMID: 29415126 DOI: 10.1093/jnen/nly008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Immunomodulation and tumor-induced tolerance is one of the central mechanisms in the oncogenesis of malignant and benign neoplasms. While numerous pathways have been described, signaling through the programmed death receptor 1 (PD-1) on T lymphocytes, via activation through its ligand, programmed death ligand 1 (PD-L1) expressed on tumor cells is one of the central pathways involved in tumor-induced tolerance. While the neoplastic component of germinomas of the CNS is the germ cell, these tumors also exhibit an abundance of quiescent tumor-infiltrating lymphocytes. We therefore investigated whether PD-L1 expression may be responsible for germinoma-induced T cell anergy, and if these tumors may be susceptible to immunotherapy. Pathologic specimens obtained from 21 cases of CNS germinomas between 2000 and 2016 were analyzed for the presence of PD-L1 and PD-1 expression by immunohistochemistry. Nineteen of 21 germinomas (90%) harbored germ cell components that stained positively for PD-L1. Positive lymphocyte staining for PD-L1 was evident in 16 cases. PD-1 expression was largely confined to lymphocytes; PD-L1 therefore may contribute to lymphocyte quiescence observed in these tumors. These results raise the possibility that immune checkpoint inhibitors such as nivolumab may have a therapeutic role in future treatment of germinomas.
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Affiliation(s)
- Miriam E Wildeman
- Department of Pathology (Neuropathology), University of Virginia, Charlottesville, Virginia
| | - Matthew J Shepard
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Edward H Oldfield
- Department of Neurological Surgery (Posthumous), University of Virginia, Charlottesville, Virginia
| | - M Beatriz S Lopes
- Department of Pathology (Neuropathology) and Neurological Surgery, University of Virginia, Charlottesville, Virginia
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7
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A Rare Localized Pituitary Stalk Germinoma Presenting in the Third Decade. Case Rep Endocrinol 2018; 2018:1746917. [PMID: 30647977 PMCID: PMC6311725 DOI: 10.1155/2018/1746917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 08/16/2018] [Indexed: 12/28/2022] Open
Abstract
We report the case of a 34-year-old male Hispanic patient who presented with an 8-month history of polyuria and decreased libido. An evaluation revealed hypopituitarism, central diabetes insipidus, and a pituitary stalk lesion. No evidence of a neoplasm or an inflammatory/infiltrative disease was found. We treated the patient conservatively with steroid therapy. However, as a result of disease progression, transsphenoidal surgery was performed to obtain tissue for a pathological analysis. Histopathology revealed an intrasellar germinoma, confirmed by immunochemistry. Due to localized disease, radiotherapy was initiated and clinical improvement was noted. This case emphasizes the importance of histopathological analysis; for many physicians, the presentation of a pituitary stalk lesion in a young male adult creates a clinical conundrum. Although the most common etiologies are an inflammatory or secondary neoplasm, the possible presence of an intrasellar neoplasm should not be ruled out. In many cases, imaging characteristics and tumor markers may aid in the diagnosis without the need of an aggressive diagnostic approach. However, in this case, histopathological analysis was the only way to make a correct diagnosis and provide adequate treatment for the patient.
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8
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Proton therapy for pediatric malignancies: Fact, figures and costs. A joint consensus statement from the pediatric subcommittee of PTCOG, PROS and EPTN. Radiother Oncol 2018; 128:44-55. [PMID: 29937209 DOI: 10.1016/j.radonc.2018.05.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/11/2018] [Accepted: 05/15/2018] [Indexed: 12/18/2022]
Abstract
Radiotherapy plays an important role in the management of childhood cancer, with the primary aim of achieving the highest likelihood of cure with the lowest risk of radiation-induced morbidity. Proton therapy (PT) provides an undisputable advantage by reducing the radiation 'bath' dose delivered to non-target structures/volume while optimally covering the tumor with tumoricidal dose. This treatment modality comes, however, with an additional costs compared to conventional radiotherapy that could put substantial financial pressure to the health care systems with societal implications. In this review we assess the data available to the oncology community of PT delivered to children with cancer, discuss on the urgency to develop high-quality data. Additionally, we look at the advantage of combining systemic agents with protons and look at the cost-effectiveness data published so far.
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9
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Fu H, Guo X, Li R, Xing B. Radiotherapy and chemotherapy plus radiation in the treatment of patients with pure intracranial germinoma: A meta-analysis. J Clin Neurosci 2017; 43:32-38. [PMID: 28602629 DOI: 10.1016/j.jocn.2017.05.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the efficiency of radiotherapy (RT) only and chemotherapy plus radiotherapy (CRT) strategy in the treatment of pure intracranial germinoma. METHODS We searched PUBMED, EMBASE, Medline and Cochrane library up to May 2016 for studies that enrolled patients with pure intracranial germinoma receiving either RT only or CRT treatment as their first-line treatment. The meta-analysis was conducted on the overall survival rate (OS) and disease free survival (DFS) at 3years and 5years. The outcomes were pooled using a random-effect model. RESULTS The final search included 15 studies with 310 patients. The pooled 3-year OS (97% vs. 94%, p=.000) and 3-year DFS (96% vs. 93%, p=0.043) of CRT group was significantly higher than that of RT only group. However, at 5years, the OS was 94% in RT only group and 92% in the combined group (p=0.29) . For DFS, the RT only group was higher than the combined group (94% vs.89%, p=.000). CONCLUSIONS Both RT and CRT for intracranial pure germinoma gain satisfying outcomes, and the CRT strategy has a higher overall survival rate and disease free survival rate at 3years than RT regimen. At 5years in the postoperative period, the advantage of survival rates for CRT is eliminated or even reversed. For patients with pure intracranial germinoma, especially those with acute and severer condition and poorer prognosis, CRT strategy would be a better choice.
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Affiliation(s)
- Hanhui Fu
- Department of Neurosurgery, Peking Union Medical College Hospital, China Pituitary Disease Registry Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Xiaopeng Guo
- Department of Neurosurgery, Peking Union Medical College Hospital, China Pituitary Disease Registry Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Ran Li
- Department of Neurosurgery, Peking Union Medical College Hospital, China Pituitary Disease Registry Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Bing Xing
- Department of Neurosurgery, Peking Union Medical College Hospital, China Pituitary Disease Registry Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, People's Republic of China.
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10
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Cormenzana Carpio M, Nehme Álvarez D, Hernández Marqúes C, Pérez Martínez A, Lassaletta Atienza A, Madero López L. Tumores germinales intracraneales: revisión de 21 años. An Pediatr (Barc) 2017; 86:20-27. [DOI: 10.1016/j.anpedi.2016.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 11/16/2022] Open
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12
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Han JW, Koh KN, Kim JY, Baek HJ, Lee JW, Shim KW, Cho J, Kim DS. Current Trends in Management for Central Nervous System Germ Cell Tumor. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2016. [DOI: 10.15264/cpho.2016.23.1.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jung Woo Han
- Division of Pediatric Hemato-Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System
| | - Kyung-Nam Koh
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine & Asan Medical Center, Seoul
| | - Ji Yoon Kim
- Department of Pediatrics, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu
| | - Hee Jo Baek
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Gwangju
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Kyu-Won Shim
- Department of Pediatric Neurosurgery, Severance Hospital, Yonsei University Health System
| | - Jaeho Cho
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Dong-Seok Kim
- Department of Pediatric Neurosurgery, Severance Hospital, Yonsei University Health System
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13
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Huo L, Wang X, Allen PK, Wang L, Liao Y, Han Z, Shen L, Tu Q, Zhong M, Zhuang Y, Li J, Hong J. Predictors of long-term survival following postoperative radiochemotherapy for pathologically confirmed suprasellar germ cell tumors. Mol Clin Oncol 2014; 3:430-434. [PMID: 25798281 DOI: 10.3892/mco.2014.461] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/10/2014] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to evaluate the predictors of long-term survival following postoperative therapy for suprasellar germ cell tumors (GCTs). A total of 23 patients with pathologically confirmed suprasellar GCTs were reviewed between April, 1987 and October, 2008. The predictors were identified with a univariate Cox proportional hazards model and the results were used to group patients according to outcome. The overall survival (OS) and progression-free survival (PFS) rates for the good- and poor-prognosis two groups were estimated with Kaplan-Meier analysis, with log-rank tests used to assess differences between the groups. The OS rate for all patients was 82.6% at 5 and 72.9% at 10 years. Lesion size (2-4 vs. >4 cm) and pathological type (pure germinoma vs. mixed GCT) were the only significant predictors of OS (P<0.05). The OS rate for the good-prognosis group was 92.9% at both 5 and 10 years, whereas the corresponding rates for the poor-prognosis group were 66.7 and 40.0%, respectively (P=0.020). The PFS rate for the good-prognosis group was 92.9% at 5 and 85.7% at 10 years, whereas the corresponding PFS rates for the poor-prognosis group were 44.4 and 33.3%, respectively (P=0.007). Lesion size and histology predicted outcome following postoperative therapy for suprasellar GCT. Therefore, pathological diagnosis is recommended whenever possible, as histology may dictate the choice of treatment.
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Affiliation(s)
- Lei Huo
- Departments of Neurosurgery, Xiangya Hospital, Central South University, Institute of Skull Base Surgery and Neurooncology, Changsha, Hunan 410008, P.R. China
| | - Xia Wang
- Radiation Oncology, Xiangya Hospital, Central South University, Institute of Skull Base Surgery and Neurooncology, Changsha, Hunan 410008, P.R. China
| | - Pamela K Allen
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Longyun Wang
- Radiation Oncology, Xiangya Hospital, Central South University, Institute of Skull Base Surgery and Neurooncology, Changsha, Hunan 410008, P.R. China
| | - Yuping Liao
- Radiation Oncology, Xiangya Hospital, Central South University, Institute of Skull Base Surgery and Neurooncology, Changsha, Hunan 410008, P.R. China
| | - Zaide Han
- Department of Radiology, Xiangya Hospital, Central South University, Institute of Skull Base Surgery and Neurooncology, Changsha, Hunan 410008, P.R. China
| | - Liangfang Shen
- Radiation Oncology, Xiangya Hospital, Central South University, Institute of Skull Base Surgery and Neurooncology, Changsha, Hunan 410008, P.R. China
| | - Qingsong Tu
- Radiation Oncology, Xiangya Hospital, Central South University, Institute of Skull Base Surgery and Neurooncology, Changsha, Hunan 410008, P.R. China
| | - Meizuo Zhong
- Radiation Oncology, Xiangya Hospital, Central South University, Institute of Skull Base Surgery and Neurooncology, Changsha, Hunan 410008, P.R. China
| | - Yan Zhuang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jing Li
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jidong Hong
- Radiation Oncology, Xiangya Hospital, Central South University, Institute of Skull Base Surgery and Neurooncology, Changsha, Hunan 410008, P.R. China
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Long-term follow-up and quality of life in patients with intracranial germinoma. Neurosurg Rev 2014; 37:445-50; discussion 451. [PMID: 24715277 DOI: 10.1007/s10143-014-0544-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 01/27/2014] [Accepted: 01/28/2014] [Indexed: 12/30/2022]
Abstract
Intracranial germinomas are fairly rare tumors occurring mostly in children or young adults with a comparatively good prognosis. Radiation is the preferred treatment of choice for this diagnosis. It has been thoroughly studied to what extent radiation doses and fields can be limited in order to avoid side effects in these young patients. The role of chemotherapy remains unclear, whereas surgery is limited to biopsy for proof of histology. Regarding the good overall survival rate, quality of life is a significant aspect to consider in these patients. We present a single institution analysis of patients with intracranial germinoma and analyze the long-term outcome with special regard to quality of life. Thirty-three patients with intracranial germinomas were analyzed by chart review, telephone interview, and neurological assessment. Additionally, a survey on quality of life was performed. The 10-year overall survival rate was 82.1 % at a mean follow-up of 141 (22-306) months. Three quarters (76 %) of the patients reached a favorable neurological outcome on the Modified Rankin Scale (mRS 0-2). However, the self-reported quality of life was significantly worse in germinoma patients compared with a healthy control group (p < 0.001). Surgical resection of the tumor led to no improvement regarding overall survival, neurological outcome, and quality of life. In terms of cognitive functioning, patients with tumor resection were significantly more impaired than biopsied patients (p = 0.04). Although germinomas are efficiently treatable tumors, the restrictions in quality of life in these often young patients are considerable, including financial difficulties. There seems no justification for tumor resection in newly diagnosed cases suspicious for germinoma as the cognitive outcome is worse than in biopsied patients, and there is no effect on overall survival.
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Treatment strategy for intracranial primary pure germinoma. Childs Nerv Syst 2013; 29:239-48. [PMID: 22965772 DOI: 10.1007/s00381-012-1902-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 08/25/2012] [Indexed: 10/27/2022]
Abstract
OBJECT This prospective randomized clinical study will address the efficacy of radiation (RT)-alone and combined with pre-RT chemotherapy (CTX) treatments and propose the novel standard treatment strategy for intracranial primary pure germinoma. MATERIALS AND METHODS Between 2005 and 2008, there were 54 patients diagnosed with intracranial primary pure germinomas in a single institute. Twenty-eight patients were enrolled. The mean age of the patients was 16.2 years (range 6-31 years). There were 19 men and 9 women (men/women ratio = 2.1:1). There were 21 patients with solitary tumors and 7 with multiple tumors. These patients were randomized as RT-only treatment group (11 solitary and 3 multiple tumors) and combined (10 solitary and 4 multiple tumors, neo-adjuvant CTX followed by response-adapted RT) treatment group. The follow-up period for RT only group has a median of 58 months (mean 58.2 months, range 41-82 months), and for combine therapy group, the median was 68.5 months (mean 67.8 months, range 41-88 months). All 14 patients in the RT-only group showed complete response (CR) and no recurrence. Eleven patients in the combined group had CR and three patients had partial response after neo-adjuvant CTX. All patients responded to RT as CR without recurrence. At the time of analysis, all 28 patients were alive without evidence of disease. CONCLUSION Neo-adjuvant CTX for localized germinomas seems to be unnecessary as a method to reduce radiation dose in our RT protocol. However, the effective control of multifocal or disseminated germinoma can be achieved by neo-adjuvant CTX followed by response-adapted reduced dose RT.
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16
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Carlos Chung KH, Owler BK, Dexter M, Chaseling R. Paediatric germ cell tumours of the central nervous system: Results and experience from a tertiary-referral paediatric institution in Australia. J Clin Neurosci 2013; 20:514-9. [PMID: 23317752 DOI: 10.1016/j.jocn.2012.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 04/03/2012] [Accepted: 04/14/2012] [Indexed: 10/27/2022]
Abstract
A retrospective analysis was conducted on consecutive patients with intracranial germ cell tumours diagnosed and treated from 1 January 1997 to 31 December 2007 to assess and determine demographic factors and treatment outcomes of children with these tumours treated in a major paediatric referral hospital in Australia. In this study, intracranial germ cell tumours represented 4.8% of paediatric brain tumours seen. Of the 21 patients identified, 15 (71.4%) were diagnosed with pure germinoma and six (28.6%) with non-germinomatous germ cell tumours (NGGCT) or mixed tumours. One patient received chemotherapy alone, two patients were treated with radiation alone and the remaining 18 received a combination of chemotherapy and radiotherapy. A total of 33 neurosurgical operations were performed with 15 biopsies via open, endoscopic or transphenoidal means; nine open resections; and nine procedures for hydrocephalus comprising seven third ventriculostomies and two ventriculoperitoneal shunts. For patients with pure germinomas, the 5-year disease-free rate (DFS) was 93.3%, and overall survival (OS) rate was 100% compared to NGGCT or mixed tumours (DFS 50%; OS 50%) (DFS p=0.019, OS p=0.004). The data presented show that pure germinomas carry a favourable prognosis. The data also support that treatment with induction chemotherapy followed by dose-attenuated radiotherapy is an effective alternative with results comparable to historical controls treated with craniospinal irradiation. Although chemoradiotherapy has become the mainstay of treatment in intracranial germ cell tumours, surgery remains integral to the management of this condition. Surgery remains important in establishing the histological diagnosis, as well as in the treatment of hydrocephalus. Furthermore, debulking procedures may be advocated in NGGCT as they are often resistant to chemotherapy.
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Affiliation(s)
- K H Carlos Chung
- T. Y. Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
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17
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Von Rohr E, Gönner F, Schroth G, Cerny T. Relapse and subarachnoid dissemination of a pineal germinoma 14 years after radiation therapy. J Clin Neurosci 2012; 6:247-9. [PMID: 18639162 DOI: 10.1016/s0967-5868(99)90514-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/1998] [Accepted: 11/23/1998] [Indexed: 11/24/2022]
Abstract
Intracranial germinomas are rare tumours which are highly curable with radiotherapy. In recent years treatment with chemotherapy has gained importance. Recurrence and dissemination is seen in about 10-20% of cases within the first 2 years after diagnosis; late recurrence and dissemination is very rare. We describe a patient with a recurrent germinoma 14 years after radiotherapy of a pineal tumour. We further report the management with chemotherapy, the late side effects of radiotherapy and the course of the disease with its fatal dissemination. We conclude that the use of radiotherapy, despite being highly effective, is clearly limited by its late side-effects. New regimens with chemotherapy seem promising but proved to be less effective in our case with tumour seeding throughout the subarachnoid space.
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Affiliation(s)
- E Von Rohr
- Department of Neuroradiology, University Hospital Bern, Switzerland
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18
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Nagaishi M, Suzuki R, Tanaka Y, Hoya K, Narita Y, Shinomiya A, Shibui S, Hyodo A. Pure germinoma of the pineal gland with synchronous spinal dissemination--case report. Neurol Med Chir (Tokyo) 2011; 50:505-8. [PMID: 20587981 DOI: 10.2176/nmc.50.505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An 11-year-old boy presented with pineal pure germinoma with spinal dissemination manifesting as a 1-month history of ocular motility disturbance and a history of abnormal sensations in the left leg persisting for several months. His past medical history was unremarkable. Craniospinal magnetic resonance imaging showed an enhanced tumor in the pineal gland and widespread leptomeningeal dissemination in the spinal canal. Biopsy of the pineal tumor was performed. Histological examination revealed a pure germinoma. Chemotherapy with carboplatin and etoposide in combination with radiotherapy induced complete remission of the tumors. He regained normal eye movement and sensation in his left leg during the chemotherapy period. Germinomas with dissemination are generally more malignant and refractory than solitary germinomas, but this patient showed a strong response to chemoradiotherapy.
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Affiliation(s)
- Masaya Nagaishi
- Department of Neurosurgery, Koshigaya Hospital Dokkyo University School of Medicine, Koshigaya, Saitama, Japan.
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MacDonald SM, Trofimov A, Safai S, Adams J, Fullerton B, Ebb D, Tarbell NJ, Yock TI. Proton Radiotherapy for Pediatric Central Nervous System Germ Cell Tumors: Early Clinical Outcomes. Int J Radiat Oncol Biol Phys 2011; 79:121-9. [DOI: 10.1016/j.ijrobp.2009.10.069] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 10/27/2009] [Accepted: 10/27/2009] [Indexed: 11/26/2022]
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20
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Foote M, Millar BA, Sahgal A, Ménard C, Payne D, Mason W, Laperriere N. Clinical outcomes of adult patients with primary intracranial germinomas treated with low-dose craniospinal radiotherapy and local boost. J Neurooncol 2010; 100:459-63. [PMID: 20455001 DOI: 10.1007/s11060-010-0206-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 04/14/2010] [Indexed: 12/17/2022]
Abstract
The authors document the long term follow up of adult patients with histologically proven primary intracranial germinoma treated with radiotherapy alone using a craniospinal with local boost technique. A retrospective review was conducted on adults diagnosed with intracranial germinoma who received radiotherapy at the Princess Margaret Hospital, Toronto from 1990 to 2007. The study group consisted of 10 males with a median age of 24.1 years. All patients received radiotherapy alone using craniospinal radiotherapy and local boost. There were 10 patients (all male) with a median follow up of 10.9 years (range 2.2-18.9 years). At date of last follow up all patients were still alive, none with relapsed disease. Seven of ten patients (70%) had panhypopituitarianism prior to commencing radiotherapy and hormonal function was not affected in those with an intact pituitary axis. There was no reported cognitive decline in the treated cohort. For adult intracranial germinomas, with long term follow up, low-dose craniospinal radiotherapy with in field boost is highly effective with minimal morbidity.
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Affiliation(s)
- M Foote
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
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21
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Yoo KH, Lee SH, Lee J, Sung KW, Jung HL, Koo HH, Lim DH, Kim JH, Shin HJ. Improved outcome of central nervous system germ cell tumors: implications for the role of risk-adapted intensive chemotherapy. J Korean Med Sci 2010; 25:458-65. [PMID: 20191048 PMCID: PMC2826748 DOI: 10.3346/jkms.2010.25.3.458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 06/25/2009] [Indexed: 11/20/2022] Open
Abstract
To determine the impact of treatment protocols on the outcome of central nervous system germ cell tumors (CNS-GCTs), we reviewed the medical records of 53 patients who received front-line chemotherapy from September 1997 to September 2006. Pure germinoma, normal alpha-fetoprotein level and beta-human chorionic gonadotropin level <50 mIU/mL were regarded as low-risk features and the others as high-risk. Patients from different time periods were divided into 3 groups according to the chemotherapy protocols. Group 1 (n=19) received 4 cycles of chemotherapy comprising cisplatin, etoposide and bleomycin. Group 2 (n=16) and group 3 (n=18) received 4 cycles of chemotherapy with cisplatin, etoposide, cyclophosphamide and vincristine in the former and with carboplatin, etoposide, cyclophosphamide and bleomycin in the latter. In group 2 and group 3, high-risk patients received double doses of cisplatin, carboplatin and cyclophosphamide. Radiotherapy was given after chemotherapy according to the clinical requirements. The event-free survivals of groups 1, 2, and 3 were 67.0%, 93.8%, and 100%, respectively (group 1 vs. 2, P=0.06; group 2 vs. 3, P=0.29; group 1 vs. 3, P=0.02). Our data suggest that risk-adapted intensive chemotherapy may improve the outcome of patients with malignant CNS-GCTs.
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Affiliation(s)
- Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Hyun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeehun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Lim Jung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Hyun Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lou X, Ma L, Wang FL, Tang ZP, Huang H, Cai YQ, Wong EHC. Susceptibility-weighted imaging in the diagnosis of early basal ganglia germinoma. AJNR Am J Neuroradiol 2009; 30:1694-9. [PMID: 19581340 DOI: 10.3174/ajnr.a1696] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Germinomas originating from the basal ganglia (BG) are rare. Early diagnosis is important for favorable prognosis, but it is difficult due to the slow clinical course and subtle changes on neuroimaging. The purpose of this study was to evaluate the usefulness of susceptibility-weighted imaging (SWI) in the diagnosis of early BG germinoma. MATERIALS AND METHODS From 2006 to 2008, 6 BG germinomas were diagnosed in children at our institution by pathology. Conventional MR imaging and SWI were available in all cases. Clinical, neuroradiologic, and follow-up features were retrospectively studied. RESULTS Three cases were classified as early BG germinomas. Conventional MR imaging demonstrated that the tumor size was <10 mm in the largest diameter. The tumors were invisible or showed slight hyperintensity on T1-weighted images (T1WI) and patchy slight hyperintensity on T2-weighted images (T2WI) without mass effect or enhancement. On SWI, the tumors appeared as obvious hypointensity in the globus pallidus and putamen, and the size was larger than that on conventional T1WI and T2WI. The other 3 cases with tumor size >10 mm in largest diameter were classified as late BG germinomas, with tumor necrosis, fluid-fluid levels, and perifocal edema, including 1 case with subependymal spread. On SWI, only the solid portion of the tumors showed hypointensity. No recurrence was noted on follow-up. CONCLUSIONS SWI appears to be more sensitive in detecting early BG germinomas than conventional MR imaging. This capability may prove to be useful in future attempts to characterize early BG germinomas.
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Affiliation(s)
- X Lou
- Department of Radiology, People's Liberation Army General Hospital, Beijing, China
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23
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Hao S, Liu B, Tang J, Jia G, Zhang Y, Ma Z, Wang Z. Germinoma of basal ganglia in female: case report and review of the literature. Childs Nerv Syst 2009; 25:613-7. [PMID: 19082612 DOI: 10.1007/s00381-008-0769-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Revised: 08/09/2008] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Germinoma of basal ganglia in female is very rare. The authors present a case of germinoma located in the right temporal lobe and basal ganglia in female and raise a hypothesis for the sex disparity. MATERIALS AND METHODS A 13-year-old Chinese girl complained of weakness in the left extremities and intermittent headache for 2 years. Neuroimaging revealed an irregular lesion in the temple lobe and basal ganglia. A temporal polectomy was performed for the tumor. RESULTS AND DISCUSSION Histopathologic examination confirmed germinoma. The patient remains stable and tumor-free for 36 months after radiotherapy and chemotherapy. The authors' hypothesis is that it is the individual hormone balance which leads to the male predominance of germinoma in the basal ganglia.
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Affiliation(s)
- Shuyu Hao
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China
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24
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Hadziahmetovic M, Clarke JW, Cavaliere R, Mayr NA, Montebello JF, Grecula JC, Newton HB, Chang EL, Lo SS. CNS germinomas: what is the best treatment strategy? Expert Rev Neurother 2008; 8:1527-36. [PMID: 18928345 DOI: 10.1586/14737175.8.10.1527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CNS germ cell tumors are rare primary brain malignancies. Germinomas comprise approximately two-thirds of CNS germ cell tumors. Owing to their radiosensitivity, radiotherapy has been used to treat patients with CNS germinomas, with favorable treatment outcomes. Historically, craniospinal irradiation has been used. Given the concerns over long-term toxicities associated with craniospinal irradiation, reduced volume radiotherapy with or without chemotherapy has been employed. Data on the use of different strategies in the treatment of CNS germinomas are emerging but a standard strategy has not been established. This article reviews the different strategies used in the management of CNS germinomas.
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Affiliation(s)
- Mersiha Hadziahmetovic
- Department of Radiation Oncology, The University of Texas Medical Branch, Trauma Center, 301 University Boulevard, Galveston, TX 77555-1178, USA.
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Cho J, Choi JU, Kim DS, Suh CO. Low-dose craniospinal irradiation as a definitive treatment for intracranial germinoma. Radiother Oncol 2008; 91:75-9. [PMID: 19019472 DOI: 10.1016/j.radonc.2008.10.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 10/21/2008] [Accepted: 10/23/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine the optimal radiotherapy (RT) dose and volume for treatment of intracranial germinoma. MATERIALS AND METHODS Eighty-one intracranial germinoma patients (33 pathologically-verified; 48 presumed by radiosensitivity testing) treated with RT alone between 1971 and 2002 were analyzed. The RT volume varied from focal (13) to whole brain (8), or to the entire neuraxis (60). All the cases after 1982 received craniospinal irradiation (CSI). Radiation dose was reduced gradually during the study period from 59 to 39.3 Gy for primary tumors, and from 34.2 to 19.5 Gy for the neuraxis. The median follow-up time was 120 months (48-260 months). RESULTS Five- and ten-year relapse-free survival rates were 98.8% and 94.1%, respectively. All the recurrences occurred in the patients who received local (4/13) or whole brain RT (1/8). None of the patients who received CSI suffered from a recurrence. Forty-six patients received 45 Gy or less to the primary site and 22 patients received less than 20 Gy to the spinal axis. CONCLUSION Low-dose CSI-based RT should remain the standard treatment for intracranial germinoma. The RT dose can be reduced to 39.3 Gy for primary tumor sites and to 19.5 Gy for the spinal axis.
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Affiliation(s)
- Jaeho Cho
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
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26
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Eom KY, Kim IH, Park CI, Kim HJ, Kim JH, Kim K, Kim SK, Wang KC, Cho BG, Jung HW, Heo DS, Kang HJ, Shin HY, Ahn HS. Upfront chemotherapy and involved-field radiotherapy results in more relapses than extended radiotherapy for intracranial germinomas: modification in radiotherapy volume might be needed. Int J Radiat Oncol Biol Phys 2008; 71:667-71. [PMID: 18514777 DOI: 10.1016/j.ijrobp.2008.01.061] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Revised: 01/11/2008] [Accepted: 01/13/2008] [Indexed: 11/25/2022]
Abstract
PURPOSE To retrospectively compare the outcome of upfront chemotherapy plus radiotherapy (CRT) and the outcome of the use of extended radiotherapy (RT) only for intracranial germinoma. METHODS AND MATERIALS Of 81 patients with tissue-confirmed intracranial germinoma, 42 underwent CRT and 39 underwent RT only. For CRT, one to five cycles of upfront chemotherapy was followed by involved-field or extended-field RT, for which the dose was dependent on the M stage. For RT only, all 39 patients underwent craniospinal RT alone. The median follow-up was 68 months. RESULTS The 5- and 10-year overall survival rate was 100% and 92.5% for RT alone and 92.9% and 92.9% for CRT, respectively. The 5-year recurrence-free survival rate was 100.0% for RT and 88.1% for CRT (p = 0.0279). No recurrences developed in patients given RT, but four relapses developed in patients who had received CRT -- three in the brain and one in the spine. Only one patient achieved complete remission from salvage treatment. The proportion of patients requiring hormonal replacement was greater for patients who received RT than for those who had received CRT (p = 0.0106). CONCLUSIONS The results of our study have shown that the better quality of life provided by CRT was compensated for by the greater rate of relapse. The possible benefit of including the ventricles in involved-field RT after upfront chemotherapy, specifically for patients with initial negative seeding, should be addressed in a prospective study.
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Affiliation(s)
- Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
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An Evaluation of Conformal and Intensity-modulated Radiotherapy in Whole Ventricular Radiotherapy for Localised Primary Intracranial Germinomas. Clin Oncol (R Coll Radiol) 2008; 20:253-60. [DOI: 10.1016/j.clon.2007.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 11/07/2007] [Accepted: 12/03/2007] [Indexed: 11/23/2022]
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Fujii Y, Saito Y, Ogawa T, Fujii S, Kamitani H, Kondo S, Horie Y, Togawa M, Senda M, Maegaki Y, Ohno K. Basal ganglia germinoma: diagnostic value of MR spectroscopy and (11)C-methionine positron emission tomography. J Neurol Sci 2008; 270:189-93. [PMID: 18371980 DOI: 10.1016/j.jns.2008.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 01/28/2008] [Accepted: 02/04/2008] [Indexed: 12/19/2022]
Abstract
We herein report a 12-year-old girl with a basal ganglia germinoma who presented with right-sided hemiparesis after a minor head trauma. Magnetic resonance (MR) imaging revealed a minimally enhanced lesion involving the left putamen, thalamus, and corona radiata. The lesion showed low-signal intensity on T1-, and high intensity on T2- and diffusion-weighted imaging. The MR signal in the adjacent globus pallidum was also low on T2-weighted imaging. MR spectroscopy on the lesion showed a large lactate/lipid/macromolecule peak with a decreased NAA/Cr ratio, but no increase in the Cho/Cr ratio. However, posttraumatic infarction at the territory of lateral lenticulostriate artery was ruled out 1 month later. This was based on progression of the hemiparesis and neuroimaging results, including an increased Cho/Cr ratio and weak uptake on (11)C-methionine positron emission tomography of the basal ganglia lesion. Stereotaxic brain biopsy confirmed the diagnosis of germinoma.
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Affiliation(s)
- Yuji Fujii
- Division of Child Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Japan.
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Villani A, Bouffet E, Blaser S, Millar BA, Hawkins C, Bartels U. Inherent diagnostic and treatment challenges in germinoma of the basal ganglia: a case report and review of the literature. J Neurooncol 2008; 88:309-14. [PMID: 18365143 DOI: 10.1007/s11060-008-9568-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Accepted: 03/04/2008] [Indexed: 12/12/2022]
Abstract
Among intracranial germinomas, basal ganglia germinomas represent a specific clinical and anatomical entity. Based on an unusual case of a basal ganglia germinoma in a 13-year-old Caucasian male, we highlight the diagnostic challenges and discuss treatment considerations in this disease.
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Affiliation(s)
- Anita Villani
- Division of Paediatrics, The Hospital for Sick Children, Toronto, Canada
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30
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Tang J, Ma Z, Luo S, Zhang Y, Jia G, Zhang J. The germinomas arising from the basal ganglia and thalamus. Childs Nerv Syst 2008; 24:303-6. [PMID: 17882439 DOI: 10.1007/s00381-007-0460-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Revised: 06/17/2007] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To introduce the features of germinomas arising from the basal ganglia (BG) and thalamus. METHOD Retrospective analysis was done with the clinical cases of germinomas in BG and thalamus from 1996 to 2000. The data included the symptoms, signs, neuroimaging findings, treatment, and outcomes. RESULT Fourteen cases were included, only one female was included. The main symptoms are disorder of numbness and weakness in limbs. Neuroimaging showed no or mild peritumor high signal in T2 weighted imaging of magnetic resonance, accompanied with cyst, calcification or bleeding. Total gross resection was obtained in nine cases, subtotal resection in four. Follow-up data were available in 11 cases with average of 56 months. Eight cases underwent only postoperative radiotherapy, one underwent only chemotherapy, and two underwent both. One case died of complication 6 months after chemotherapy, the rest lived good life. CONCLUSION Germinoma in BG and thalamus predominate in a boy. The neuroimaging features are very informative for diagnosis. Surgical resection should not be the first choice although it is has lesser complications. The long-term outcome is favorable.
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Affiliation(s)
- Jie Tang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital University of Medical Sciences, Tiantan Xili 6, Beijing 100050, People's Republic of China.
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Long term outcomes in patients with intracranial germinomas: a single institution experience of irradiation with or without chemotherapy. J Neurooncol 2008; 88:161-7. [DOI: 10.1007/s11060-008-9542-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 02/04/2008] [Indexed: 11/25/2022]
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32
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MacDonald SM, Desai N, Heller G, Rolnitzky L, Allen JC. MRI changes in the "normal" pineal gland following chemotherapy for suprasellar germ cell tumors. Pediatr Hematol Oncol 2008; 25:5-15. [PMID: 18231950 DOI: 10.1080/08880010701665777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Primary CNS germ cell tumors (GCT) arise in the suprasellar and pineal regions. Suprasellar GCT may remain radiographically occult during the early symptomatic period. Although theoretically possible, it is more difficult to identify presymptomatic disease in the pineal region. Given the sensitivity of GCT to cytotoxic therapy, a decrease in size of the "normal" pineal gland following chemotherapy (CHT) could divulge preexisting disease. Such information may impact radiation treatment (RT). The authors reviewed MRIs of 15 patients with suprasellar GCT treated with pre-RT CHT. They defined a > or =50% reduction in volume of the pineal gland as a substantial decrease suspicious for preexisting occult disease. As controls, MRIs of 11 medulloblastoma patients who received cytotoxic therapy were reviewed. Pineal gland volumes could be determined for 12 of 15 patients with GCT and 7 of 11 patients with medulloblastoma. The study radiologists concurred that 2/12 GCT patients and 0/7 medulloblastoma patients had > or =50% volumetric reduction. When radiation is delivered as the sole treatment modality, the pineal region is included in at least the initial volume, but in certain clinical trials RT volume is reduced to only the suprasellar region if a complete response is achieved following pre-RT CHT. Noting changes in the "normal" pineal gland following CHT may indicate disease. CHT alone may not be sufficient to control this disease, even in cases in which a complete response is achieved. If the intent is to deliver RT to all areas of initial disease and this phenomenon can be demonstrated on a larger scale, inclusion of the pineal should be considered for patients demonstrating a substantial decrease in the size of the pineal gland after CHT.
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Affiliation(s)
- Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Shim KW, Kim TG, Suh CO, Cho JH, Yoo CJ, Choi JU, Kim JH, Kim DS. Treatment failure in intracranial primary germinomas. Childs Nerv Syst 2007; 23:1155-61. [PMID: 17610071 DOI: 10.1007/s00381-007-0394-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 05/20/2007] [Indexed: 01/09/2023]
Abstract
OBJECT A radiation dose of 40-50 Gy is able to produce a cure rate of more than 90% in intracranial pure germinoma. However, many attempts have been made to reduce the dose and volume of radiation without compromising the disease control rate because of the toxicity of irradiation. This retrospective study is intended to provide the physician with an appropriate therapeutic strategy. MATERIALS AND METHODS We reviewed a series of 10 recurrent germinomas among 117 germinomas diagnosed histologically or clinically between 1979 and 2002. These patients involved underwent three different treatment modalities; radiation alone (N = 71), chemotherapy alone (N = 9), and combined therapy (N = 37). The 10-year overall and relapse-free survival rates were 97 and 93% in the radiation alone group, 89 and 67% in the chemotherapy alone group, and 92 and 92% in the combined therapy group, respectively. As expected, both radiation therapy and combined therapy were effective in controlling the disease. Tumor recurrence was closely related to the volume of radiation but not to the dose of radiation. If the tumor bed and craniospinal axis were fully covered, the radiation dose might be reduced. Chemotherapy alone showed earlier recurrence and a higher tumor recurrence rate. In the case of combined therapy, chemotherapy was useful in reducing the radiation dose but revealed some toxicity (death of two patients). CONCLUSIONS The investigation of a possible further dose reduction seems worthwhile. Radiation therapy alone with a dose of less than 40 Gy should be compared with ongoing chemotherapeutic protocols combined with low-dose irradiation.
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Affiliation(s)
- Kyu-Won Shim
- Department of Neurosurgery, Brain Korea 21 Project for Medical Science, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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Calugaru V, Taillibert S, Lang P, Simon JM, Delattre JY, Mazeron JJ. Chimiothérapie néoadjuvante suivie d'une radiothérapie adaptée à la réponse tumorale dans les tumeurs germinales séminomateuses du système nerveux central: expérience de l'hôpital de la Pitié-Salpêtrière et revue de la littérature. Cancer Radiother 2007; 11:122-8. [PMID: 17459755 DOI: 10.1016/j.canrad.2007.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 12/30/2006] [Accepted: 01/09/2007] [Indexed: 11/20/2022]
Abstract
PURPOSE Retrospective analysis of ten cases of germinoma of the central nervous system treated in Pitié-Salpêtrière Hospital, Paris. PATIENTS AND METHODS Ten male patients were treated from 1997 to 2005 for histologically verified primary seminoma of the central nervous system. The median age was 27 years (range 18-40 years). Our option for the treatment was the association of 3-4 cycles of neoadjuvant chemotherapy (cisplatin and etoposide) to radiotherapy. Five patients received a craniospinal radiotherapy of 30 Gy (for one patient 36 Gy) followed by a tumoral boost from 20 to 24 Gy. For five patients, irradiated volume was limited to the tumour, total dose from 24 to 54 Gy (for three patients the total dose was from 24 to 30 Gy). Surgery was used for five patients, but only in one case was macroscopic complete. RESULTS Six patients were in situation of complete remission after neoadjuvant chemotherapy. All the patients were in situation of complete remission after the irradiation. All the patients were alive free of disease with a median follow-up 46 months (range 13-90 months). CONCLUSION In spite of the fact that the intracranial germinal tumours are not the subject of a consensual treatment strategy, this retrospective analysis pleads in favour of chemotherapy followed by limited dose and volume irradiation.
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Affiliation(s)
- V Calugaru
- Service de radiothérapie oncologique, groupe hospitalier de la Pitié-Salpêtrière, APHP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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Hengstman GJD, Gons RAR, Lenssen PPA, Kappelle AC. Intracranial germinoma presenting as polyradiculopathy due to widespread spinal dissemination. J Neurooncol 2006; 80:105-6. [PMID: 16937013 DOI: 10.1007/s11060-006-9128-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Accepted: 01/19/2006] [Indexed: 11/26/2022]
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Marcus KJ. Intracranial germinomas: can we improve upon our success? Pediatr Blood Cancer 2006; 47:2-3. [PMID: 16047367 DOI: 10.1002/pbc.20528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Karen J Marcus
- Division of Radiation Oncology, Children's Hospital, Department of Radiation Oncology, Brigham and Women's/Dana Farber Cancer Care, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Védrine L, Bauduceau O, Fayolle M, Le Moulec S, Ceccaldi B. Intérêt de la chimiothérapie néoadjuvante dans le traitement des séminomes purs intracérébraux : expérience de l'hôpital du Val-de-Grâce. Cancer Radiother 2005; 9:335-40. [PMID: 16019248 DOI: 10.1016/j.canrad.2005.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Revised: 06/10/2005] [Accepted: 06/22/2005] [Indexed: 11/30/2022]
Abstract
Optimal management of intracranial germinomas remains controversial. Focal irradiation to the primary tumor followed by prophylactic craniospinal radiotherapy represents the traditional treatment resulting in excellent long-term survival but potential late effects. To decrease late effects related to extensive fields of radiotherapy, combined chemotherapy and irradiation has been tested with reduced volumes and doses of radiation therapy. We report our experience about four patients successfully treated by neoadjuvant chemotherapy with carboplatin and etoposide followed by radiotherapy delivering 26 to 36 Gy to the whole brain and 36 to 50 Gy to the initial tumor volume.
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Affiliation(s)
- L Védrine
- Service d'oncologie médicale et radiothérapie, hôpital d'instruction des armées du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris cedex 05, France.
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Rogers SJ, Mosleh-Shirazi MA, Saran FH. Radiotherapy of localised intracranial germinoma: time to sever historical ties? Lancet Oncol 2005; 6:509-19. [PMID: 15992700 DOI: 10.1016/s1470-2045(05)70245-x] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The optimum management of localised intracranial germinoma remains controversial. Cure rates for this rare CNS tumour, which arises mainly in adolescents, exceed 90% at 10 years, and limitation of treatment-related late morbidity is therefore essential. Craniospinal radiotherapy plus boost is perceived to be the gold-standard treatment, but there have been suggestions that reduced-volume radiotherapy could be adequate for cure. We reviewed publications since 1988 to compare patterns of disease relapse and cure rates after craniospinal radiotherapy, reduced-volume irradiation alone (i.e., whole-brain or whole-ventricular irradiation followed by a boost), and focal or localised irradiation alone. The recurrence rate after whole-brain or whole-ventricular radiotherapy plus boost was 7.6% compared with 3.8% after craniospinal radiotherapy, with no predilection for isolated spinal relapses (2.9% vs 1.2%). We challenge the consensus that craniospinal radiotherapy is the best treatment for localised germinomas and conclude that reduced-volume radiotherapy plus boost should replace craniospinal radiotherapy when a radiotherapy-only approach is used.
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Affiliation(s)
- S J Rogers
- Department of Neuro-Oncology and Paediatric Oncology, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
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Takeda N, Fujita K, Katayama S, Uchihashi Y, Okamura Y, Nigami H, Hashimoto K, Kohmura E. Germinoma of the basal ganglia. An 8-year asymptomatic history after detection of abnormality on CT. Pediatr Neurosurg 2004; 40:306-11. [PMID: 15821363 DOI: 10.1159/000083745] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2004] [Accepted: 09/15/2004] [Indexed: 12/15/2022]
Abstract
We describe a case of germinoma of the left basal ganglia. An 11-year-old boy, who demonstrated calcification of the left basal ganglia on CT scan following a head injury at the age of 3 years, presented with a weakness of the right upper extremity for 2 months. MRI demonstrated high intensity in the left basal ganglia on a T1-weighted image without enhancement as well as high intensity on a T2-weighted image. Ipsilateral hemiatrophy of the hemisphere and midbrain was also noted. In addition, high intensity in the left internal capsule and cerebral peduncle was demonstrated on T2-weighted image. Surgical specimens obtained by stereotactic biopsy showed germinoma with a two-cell pattern. The patient had remained asymptomatic for 8 years after abnormal calcification was initially detected on CT scan. Ipsilateral hemiatrophy of the hemisphere and midbrain was demonstrated before the onset of weakness.
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Affiliation(s)
- Naoya Takeda
- Department of Neurosurgery, Nishi-Kobe Medical Center, Kobe, Japan.
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Reddy AT, Wellons JC, Allen JC, Fiveash JB, Abdullatif H, Braune KW, Grabb PA. Refining the staging evaluation of pineal region germinoma using neuroendoscopy and the presence of preoperative diabetes insipidus. Neuro Oncol 2004; 6:127-33. [PMID: 15134627 PMCID: PMC1871986 DOI: 10.1215/s1152851703000243] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2003] [Accepted: 12/03/2003] [Indexed: 11/19/2022] Open
Abstract
Treatment strategies for CNS germinoma are currently evolving. Current approaches include reducing the volume and dose of radiation by adding pre-irradiation chemotherapy. Very accurate staging is necessary with such an approach to prevent failures. Eight consecutive patients with pineal germinoma at one institution underwent endoscopic surgery for tumor biopsy, direct visualization of the third ventricular region, and third ventriculostomy for those with hydrocephalus. All patients were treated with 4 cycles of chemotherapy. Conformal field radiation therapy followed, with the dose to the tumor bed dependent on the response to chemotherapy. Patients who had MRI, endoscopic, or cerebrospinal fluid evidence of multicentric or disseminated disease also received craniospinal radiation. Six patients had diabetes insipidus (DI) at presentation. All 6 had tumor studding the floor of the third ventricle on endoscopic visualization, while only 4 of those patients had MRI evidence of disease in that region. All patients have completed therapy and are alive, with no evidence of disease at median follow-up of 31.5 months from diagnosis. Direct endoscopic visualization of the third ventricular region may be more sensitive than MRI for evaluating the presence of suprasellar disease and appears to add important information. This parameter should be added to the staging evaluation when feasible. In this series, the presence of DI was 100% predictive of suprasellar disease, even when the MRI was negative for involvement of that region. Patients should be evaluated for DI as part of the initial staging, and if it is present, the patients should be treated for suprasellar disease regardless of MRI findings.
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Affiliation(s)
- Alyssa T Reddy
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
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Maity A, Shu HKG, Janss A, Belasco JB, Rorke L, Phillips PC, Sutton LN, Goldwein JW. Craniospinal radiation in the treatment of biopsy-proven intracranial germinomas: twenty-five years' experience in a single center. Int J Radiat Oncol Biol Phys 2004; 58:1165-70. [PMID: 15001260 DOI: 10.1016/j.ijrobp.2003.08.028] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2003] [Revised: 08/20/2003] [Accepted: 08/25/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE The optimal treatment for intracranial germinomas remains controversial. We report on our 25-year experience using craniospinal irradiation (CSI) for this disease. METHODS AND MATERIALS Between September 1976 and May 2001, 39 patients with biopsy-proven intracranial germinomas seen at the Children's Hospital of Philadelphia/Hospital of the University of Pennsylvania received CSI. Thirteen of 36 patients (36%) had evidence of spinal dissemination. Median doses to the whole brain, primary site, and spine were 36 Gy (range, 18-44.2 Gy), 50.4 Gy (range, 44-55.8 Gy), and 30.6 Gy (range, 18-40 Gy), respectively. RESULTS With a median follow-up of 7.1 years (range: 1.5-20.2 years), there have been no documented relapses. This includes 5 patients without spinal dissemination who received 18-19.8 Gy to the craniospinal axis; for these patients, the median length of follow-up was 5.5 years (range, 1.3-6.8 years). One patient, who had no evidence of disease 12.9 years after CSI, died of unknown causes 4 months later. CONCLUSIONS Our treatment of intracranial germinomas with CSI has yielded outstanding results with no known relapses during a long follow-up period. These results must be considered when evaluating other approaches, such as chemotherapy only or local field irradiation.
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Affiliation(s)
- Amit Maity
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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Regueiro C. Tratamiento de los tumores germinales intracraneales y otros tumores de la región pineal. Neurocirugia (Astur) 2003. [DOI: 10.1016/s1130-1473(03)70549-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fietz T, Thiel E, Baldus C, Blau IW, Stoltenburg G, Knauf WU. Successful treatment of extracranially metastasized pineal gland germinoma with high-dose methotrexate. Ann Oncol 2002; 13:1681-5. [PMID: 12377660 DOI: 10.1093/annonc/mdf276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Germinoma of the pineal gland is a rare disease usually confined to the brain which responds well to radiotherapy. Spinal seeding occurs in approximately 4% of cases and distant metastases are extremely rare. We report on a 27-year-old female with an intracranially metastasized pineal gland germinoma, meningeal carcinomatosis and distant bone metastases. Treatment was initiated with intrathecal methotrexate (MTX) and continued with high-dose intravenous MTX. The therapy was very well tolerated apart from reversible hepatic toxicity requiring a dose reduction. The patient was in complete remission after three courses followed by two consolidation cycles; the patient has now been in continuous complete remission for more than 22 months. This is the first report to show that MTX is a potent drug in treating pineal gland germinoma. Long-term side effects of radiotherapy such as reduced mental function or hypopituitarism can probably be avoided. Single-agent high-dose MTX may provide high efficacy with limited adverse effects, especially at a more advanced tumor stage with spinal seeding and extracranial disease.
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Affiliation(s)
- T Fietz
- Department of Medicine III (Hematology, Oncology and Transfusion Medicine), Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Germany.
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Aoyama H, Shirato H, Ikeda J, Fujieda K, Miyasaka K, Sawamura Y. Induction chemotherapy followed by low-dose involved-field radiotherapy for intracranial germ cell tumors. J Clin Oncol 2002; 20:857-65. [PMID: 11821471 DOI: 10.1200/jco.2002.20.3.857] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate the efficacy of chemotherapy followed by low-dose involved-field radiotherapy for the treatment of intracranial germ cell tumors (GCTs). PATIENTS AND METHODS Thirty-three patients with GCTs, including 16 pure germinomas, 11 human chorionic gonadotropin-beta (HCG-beta)-secreting germinomas, three mixed GCTs composed of immature teratomas plus germinomas (IMT/G), and three highly malignant mixed GCTs, were treated. Etoposide and cisplatin (EP) were used for the treatment of solitary pure germinomas, and ifosfamide, cisplatin, and etoposide (ICE) were used for the treatment of other GCTs. The dose schedule was 24 Gy for germinomas and 40 to 54 Gy for other GCTs. An involved-field set-up was used except for highly malignant GCTs, in which craniospinal irradiation was used. The median follow-up was 58 months (range, 18 to 102 months). RESULTS Disease-related, overall, and relapse-free survival rates at 5 years were 100%, 93%, and 69% for all patients, 100%, 100%, and 86% for patients with pure germinomas, and 100%, 75%, and 44% for patients with HCG-beta-secreting germinomas, respectively. All six patients with nongerminomatous GCTs were alive at the last follow-up. All eight relapses (one pure germinoma, five HCG-beta-secreting germinomas, and two IMT/G), except one in a course of salvage treatment, were salvaged and free of disease at the last follow-up. No decline was observed in the full-scale, verbal, or performance intelligence quotient at 12 to 51 months after the treatment in 11 patients. CONCLUSION Our results support an excellent prognosis after EP and ICE regimens followed by radiotherapy. Dose and volume can be reduced to 24 Gy in 12 fractions and involve a field set-up after EP chemotherapy for the treatment of pure germinomas.
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Affiliation(s)
- Hidefumi Aoyama
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Habrand JL, Abdulkarim B, Beaudré A, el Khouri M, Kalifa C. [Determination of target volume in pediatric radiotherapy: application to brain tumors]. Cancer Radiother 2001; 5:711-9. [PMID: 11715323 DOI: 10.1016/s1278-3218(01)00121-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pediatric tumors have enjoyed considerable improvements for the past 30 years. This is mainly due to the extensive use of combined therapeutical modalities in which chemotherapy plays a prominent role. In many children, local treatment including radiotherapy, can nowadays be adapted in terms of target volume and dose to the "response" to an initial course of chemotherapy almost on a case by case basis. This makes precise recommendation on local therapy highly difficult in this age group. We will concentrate in this paper on brain tumors in which chemotherapy is of limited value and radiotherapy still plays a key-role.
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Affiliation(s)
- J L Habrand
- Département de radiothérapie, institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif, France
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Shin KH, Kim IH, Choe G. Impacts of elevated level of hCG in serum on clinical course and radiotherapy results in the histology-confirmed intracranial germinomas. Acta Oncol 2001; 40:98-101. [PMID: 11321670 DOI: 10.1080/028418601750071145] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The prognosis of intracranial germinoma producing the human chorionic gonadotropin (hCG) is controversial due to limited information. We undertook a retrospective analysis to determine whether this type of tumor has similar clinical course and prognosis to hCG non-secreting germinoma. Thirty-one histologically confirmed intracranial germinoma patients who had pretreatment hCG examination in serum/CSF were treated with radiotherapy between 1980 and 1996. hCG level was measured by immunoradioassay of beta subunit of hCG. Six patients had elevated serum hCG levels and were defined as having hCG secreting germinoma. All except three patients received craniospinal axis irradiation. The follow-up ranged from 19-175 months with a median of 63 months. hCG secreting germinoma accounted for 19% of intracranial germinoma cases. Elevated hCG levels ranged from 39-260 IU/l in serum. No difference was found between hCG non-secreting germinoma and hCG secreting germinoma in terms of patient or treatment characteristics. There was no recurrence among the six hCG secreting germinoma patients. The 5-year overall and disease-free survival rates were 96% for patients with hCG non-secreting germinomas and 100% for the patients with hCG secreting germinomas. The survival difference was not significant (p = 0.59). Our results suggest that elevated level of hCG did not result in any differences in the clinical characteristics or survival after radical radiotherapy in histologically confirmed intracranial germinoma.
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Affiliation(s)
- K H Shin
- Department of Therapeutic Radiology, Seoul National University College of Medicine, the Institute of Radiation Medicine, Medical Research Center, Korea
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Tomura N, Takahashi S, Kato K, Okane K, Sashi R, Watanabe O, Watarai J, Ito Y, Mizoi K. Germ cell tumors of the central nervous system originating from non-pineal regions: CT and MR features. Comput Med Imaging Graph 2000; 24:269-76. [PMID: 10842052 DOI: 10.1016/s0895-6111(00)00006-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
CT and MR findings were retrospectively reviewed in 12 patients with germ cell tumors originating from the non-pineal regions. Cystic or necrotic components were seen in 6 patients. Of 4 germinomas, 2 showed mixed density on the CT. The MR signal intensity of the tumor was non-specific. Of 8 germinomas, 4 were inhomogeneously enhanced on postcontrast CT and T1-weighted MR images. CT and MR features of germinomas originating from non-pineal regions frequently differ from those of germinomas originating from the pineal region. The mass of the tumor often appeared cystic and inhomogeneously enhanced following contrast infusion.
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Affiliation(s)
- N Tomura
- Department of Radiology, School of Medicine, Akita University, 1-1-1, Hondo, Akita 010-8543, Akita City, Japan.
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Merchant TE, Sherwood SH, Mulhern RK, Rose SR, Thompson SJ, Sanford RA, Kun LE. CNS germinoma: disease control and long-term functional outcome for 12 children treated with craniospinal irradiation. Int J Radiat Oncol Biol Phys 2000; 46:1171-6. [PMID: 10725628 DOI: 10.1016/s0360-3016(99)00375-2] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To provide evidence that radiation therapy alone in the form of craniospinal irradiation (CSI) and a boost to the primary site of disease provides effective disease control and limited additional morbidity for patients with CNS germinoma. METHODS AND MATERIALS Twelve patients with a median age of 12 years (range 9-16 years) with CNS germinoma were treated with CSI (median 25.6 Gy, range 23.4-32 Gy) and a boost to the primary site of disease (50.4 Gy, range 45-54 Gy) between January 1987 and June 1998. All patients were biopsied prior to radiation therapy and none received chemotherapy. No patients were lost to follow-up and the majority had long-term (> 45 month) pre- and postirradiation endocrine and psychology assessment. RESULTS All 12 patients are alive and no failures have occurred with a median follow-up of 69 months (range 14-143 months). Preirradiation endocrine deficiencies were present in 6 of 6 suprasellar tumors and 1 of 6 pineal tumors; with follow-up there was no substantial difference between age and gender adjusted pre- and postirradiation stature and weight. With long-term follow-up, there were no significant differences between pre- and postirradiation full-scale, verbal, and performance IQ scores. CONCLUSIONS This study confirms the ability of radiation therapy alone to achieve disease control with a high rate of success in pediatric patients and demonstrates that the treatment toxicity faced by these patients may be less than anticipated. Because these patients present with substantial preexisting morbidity at diagnosis and may be of an age where the potential for radiation-related side effects is relatively small, the superiority of treatment alternatives may be difficult to prove.
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Affiliation(s)
- T E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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Shibamoto Y, Sasai K, Kokubo M, Hiraoka M. Salvage radiation therapy for intracranial germinoma recurring after primary chemotherapy. J Neurooncol 1999; 44:181-5. [PMID: 10619503 DOI: 10.1023/a:1006367316168] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Systemic chemotherapy has been increasingly used in the primary treatment of intracranial germinoma. However, the recurrence rate seems to be very high after treatment with chemotherapy alone. We used radiation to treat 5 patients harboring intracranial germinoma that recurred following primary chemotherapy. They had received systemic chemotherapy (4 with cisplatin plus etoposide and 1 with adriamycin, vincristine, cyclophosphamide, prednisolone, and cisplatin) 7-24 months before referral. All patients were treated with conventional radiotherapy directed to the primary tumor site or the craniospinal axis with a dose to the primary site ranging from 39.6 to 47.0 Gy (mean, 42.6 Gy). Response to radiation of all the recurrent tumors was good and all tumors disappeared on diagnostic imaging below the dose of 24 Gy. All patients are alive without further recurrence at 61-129 months after salvage radiotherapy. Germinomas recurring after primary chemotherapy do not seem to have acquired cross resistance to radiotherapy. They can usually be cured by standard radiation therapy with 40-47 Gy.
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Affiliation(s)
- Y Shibamoto
- Department of Oncology, Institute for Frontier Medical Sciences, Kyoto University, Japan.
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