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Shabo E, Czech T, Nicholson JC, Mallucci C, Mottolese C, Piatelli G, Frappaz D, Murray MJ, Faure-Conter C, Garrè ML, Sarikaya-Seiwert S, Weinhold L, Haberl H, Calaminus G. Evaluation of the Perioperative and Postoperative Course of Surgery for Pineal Germinoma in the SIOP CNS GCT 96 Trial. Cancers (Basel) 2022; 14:cancers14143555. [PMID: 35884617 PMCID: PMC9323477 DOI: 10.3390/cancers14143555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
Background: CNS germinoma, being marker-negative, are mainly diagnosed by histological examination. These tumors predominantly appear in the suprasellar and/or pineal region. In contrast to the suprasellar region, where biopsy is the standard procedure in case of a suspected germ-cell tumor to avoid mutilation to the endocrine structures, pineal tumors are more accessible to primary resection. We evaluated the perioperative course of patients with pineal germinoma who were diagnosed by primary biopsy or resection in the SIOP CNS GCT 96 trial. Methods: Overall, 235 patients had germinoma, with pineal localization in 113. The relationship between initial symptoms, tumor size, and postoperative complications was analyzed. Results: Of 111 evaluable patients, initial symptoms were headache (n = 98), hydrocephalus (n = 93), double vision (n = 62), Parinaud syndrome (n = 57), and papilledema (n = 44). There was no significant relationship between tumor size and primary symptoms. A total of 57 patients underwent primary resection and 54 underwent biopsy. Postoperative complications were reported in 43.2% of patients after resection and in 11.4% after biopsy (p < 0.008). Biopsy was significantly more commonly performed on larger tumors (p= 0.002). Conclusions: These results support the practice of biopsy over resection for histological confirmation of pineal germinoma.
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Affiliation(s)
- Ehab Shabo
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
- Correspondence: ; Tel.: +49-228-287-16521; Fax: +49-228-287-11366
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - James C. Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children’s Hospital, Liverpool L14 5AB, UK; (C.M.); (M.J.M.)
| | - Carmine Mottolese
- Neurochirurgie Pédiatrique, Hôpital Femme-Mère-Enfant, Université de Lyon, 59, Boulevard Pinel, 69003 Lyon, France;
| | - Gianluca Piatelli
- Division of Neurosurgery, Department of Neurosciences, Giannina Gaslini Children’s Hospital, 16147 Genvoa, Italy;
| | - Didier Frappaz
- Department of Pediatric Hematology and Oncology, Institut d’Hématologie et d’Oncologie Pédiatrique, 69008 Lyon, France; (D.F.); (C.F.-C.)
| | - Matthew Jonathan Murray
- Department of Neurosurgery, Alder Hey Children’s Hospital, Liverpool L14 5AB, UK; (C.M.); (M.J.M.)
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK
| | - Cecile Faure-Conter
- Department of Pediatric Hematology and Oncology, Institut d’Hématologie et d’Oncologie Pédiatrique, 69008 Lyon, France; (D.F.); (C.F.-C.)
| | - Maria Luisa Garrè
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Sevgi Sarikaya-Seiwert
- Section of Pediatric Neurosurgery, Department of Neurosurgery, Rheinische, Friedrich-Wilhelms-University, Sigmund-Freud-Straße 25, 53127 Bonn, Germany; (S.S.-S.); (H.H.)
| | - Leonie Weinhold
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, 53127 Bonn, Germany;
| | - Hannes Haberl
- Section of Pediatric Neurosurgery, Department of Neurosurgery, Rheinische, Friedrich-Wilhelms-University, Sigmund-Freud-Straße 25, 53127 Bonn, Germany; (S.S.-S.); (H.H.)
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany;
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Raynald, Yang H, Zhang X, Ma'ruf L, Li C, Jiang T. Primary intracranial pure endodermal sinus tumor: A retrospective series of 6 cases in a single center and a systematic review of overall survival. Neurochirurgie 2021; 67:587-598. [PMID: 33753128 DOI: 10.1016/j.neuchi.2021.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/02/2021] [Accepted: 02/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Primary intracranial pure endodermal sinus tumor (EST) is a rare malignant nongerminomatous germ cell tumor. There is still lack of knowledge about the treatment and prognosis. METHODS We studied 6 cases of primary intracranial pure EST patients in Beijing Tiantan Hospital from June 2009 to June 2015. A comprehensive literature search was performed on Pubmed's electronic database using the search terms "primary intracranial endodermal sinus tumor", "primary intracranial yolk sac tumor" and "malignant germ cell tumor". Survival rates based on age, gender, tumor location, treatment, resection degree and metastatis were collected and analyzed. RESULTS Total resection was achieved in three patients and subtotal resection was achieved in three patients. Blood AFP level continuously decreased after tumor removal. In our case series, the longest survival time was 99 months; this patient received surgery+adjuvant therapy. Fifty-two cases were eligible and met the inclusion criteria for the review analysis. The majority of the population were in the young child to adolescent age and there is a male predominance in this study. In the Kaplan-Meier survival analysis, age, gender, tumor location and metastasis did not affect patients' OS. Better OS was found in patients who had subtotal and gross total resection of the tumor. Patients who had surgery combined with adjuvant therapy showed better OS compared to those who just had surgery. CONCLUSION Total resection of the tumor is necessary and EST is sensitive to adjuvant therapy.
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Affiliation(s)
- Raynald
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, 100050 Beijing, China
| | - H Yang
- Department of Neurosurgery, Beijing, Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - X Zhang
- Emergency department, Beijing Haidian Hospital, Haidian Section of Peking University Third Hospital, 100080 Beijing, China
| | - L Ma'ruf
- Department of Neurosurgery, Gatot Subroto Central Army Hospital, Jakarta, Indonesia
| | - C Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050 Beijing, China.
| | - T Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 100050 Beijing, China.
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Jiang T, Raynald, Yang H, Zhang W, Li C. Predictive factors of overall survival in primary intracranial pure choriocarcinoma. J Clin Neurosci 2018; 61:93-101. [PMID: 30442453 DOI: 10.1016/j.jocn.2018.10.136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/27/2018] [Indexed: 12/30/2022]
Abstract
The incidence of primary intracranial pure choriocarcinoma (PIPC) is extremely rare. Only several case and case series have been previously reported; therefore, there is still lack of knowledge about the prognosis and its standard treatment. We performed a collective study of all reported cases of PIPC to identify the predictive factors related with OS. A comprehensive search was performed on Pubmed's electronic database using the terms "primary intracranial choriocarcinoma" and "malignant germ cell tumor". Data about gender, various location, the presence of intratumoral hemorrhage, metastasis and treatment modalities were extracted from the published articles and we analyzed the overall survival based on this predictive factors. 51 cases were eligible and met the inclusion criteria. The majority of the patients were in the child population (44.7%) age between 6 and 12 years old. 77.1% of the patient were male and 22.9% were female. Tumor located other than suprasellar and pineal area showed better prognosis. Median OS of PIPC was 22 months. Patient underwent gross total resection had better outcomes compared with those who only had partial or subtotal resection. Adjuvant therapy (especially chemotherapy) significantly improved OS (p = 0.000, log-rank test). PIPC is chemosensitive and metastasis is the predictive factor for poor prognosis.
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Affiliation(s)
- Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital Capital Medical University, Beijing, 100050, China.
| | - Raynald
- Department of Neurosurgery, Beijing Tiantan Hospital Capital Medical University, Beijing, 100050, China; Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100050, China
| | - Hongchao Yang
- Department of Neurointervention Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
| | - Wenhui Zhang
- Department of Neurology, The 7th Hospital of Baoding, Hebei 071000, China
| | - Chunde Li
- Department of Neurosurgery, Beijing Tiantan Hospital Capital Medical University, Beijing, 100050, China.
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Calaminus G, Frappaz D, Kortmann RD, Krefeld B, Saran F, Pietsch T, Vasiljevic A, Garre ML, Ricardi U, Mann JR, Göbel U, Alapetite C, Murray MJ, Nicholson JC. Outcome of patients with intracranial non-germinomatous germ cell tumors-lessons from the SIOP-CNS-GCT-96 trial. Neuro Oncol 2018; 19:1661-1672. [PMID: 29048505 DOI: 10.1093/neuonc/nox122] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Following promising results to increase survival and reduce treatment burden in intracranial non-germinomatous germ cell tumors (NGGCTs), we conducted a European study using dose-intense chemotherapy followed by risk-adapted radiotherapy. Methods All patients received 4 courses of cisplatin/etoposide/ifosfamide. Non-metastatic patients then received focal radiotherapy only (54 Gy); metastatic patients received 30 Gy craniospinal radiotherapy with 24 Gy boost to primary tumor and macroscopic metastatic sites. Results Patients with localized malignant NGGCT (n = 116) demonstrated 5-year progression-free survival (PFS) and overall survival (OS) of 0.72 ± 0.04 and 0.82 ± 0.04, respectively. Primary tumor sites were: 67 pineal, 35 suprasellar, 5 bifocal, 9 others. One patient died postsurgery in clinical remission; 3 patients progressed during treatment and 27 (23%) relapsed afterward. Fourteen were local, 6 combined, and 7 distant relapses (outside radiation field). Seventeen of the 27 relapsed patients died of disease. Patients with metastatic disease (n = 33) demonstrated 5-year PFS and OS of 0.68 ± 0.09 and 0.75 ± 0.08, respectively; 1 patient died following progression on treatment and 9 (27%) relapsed afterward (5 local, 1 combined, 3 distant). Only one metastatic patient with recurrence was salvaged. Multivariate analysis identified diagnostic alpha-fetoprotein level (serum and/or cerebrospinal fluid level >1000 ng/mL, 19/149 patients, of whom 11 relapsed; P < 0.0003) and residual disease following treatment, including after second-look surgery (n = 52/145 evaluable patients, 26 relapsed; P = 0.0002) as significant prognostic indicators in this cohort. Conclusion In localized malignant NGGCT, craniospinal radiotherapy could be avoided without increased relapses outside the radiotherapy field. Chemotherapy and craniospinal radiotherapy remain the gold standard for metastatic disease.
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Affiliation(s)
- Gabriele Calaminus
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Didier Frappaz
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Rolf Dieter Kortmann
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Barbara Krefeld
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Frank Saran
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Torsten Pietsch
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Alexandre Vasiljevic
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Maria Luisa Garre
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Umberto Ricardi
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Jillian R Mann
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Ulrich Göbel
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Claire Alapetite
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - Matthew J Murray
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
| | - James C Nicholson
- Radiation Oncology, Institut Curie, Paris, France; Paediatric Hematology/Oncology, University Children's Hospital Bonn, Bonn, Germany; Institute d'Hémato-Oncologie Pédiatrique, Centre Leon Berard, Lyon, France; Neuro-Oncology, G.Gaslini Children's Hospital, Genoa, Italy; ESPED University Düsseldorf, Düsseldorf, Germany; Radiation Therapy and Radio-oncology, University of Leipzig, Leipzig, Germany; Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Germany; Paediatric Oncology, Cambridge University Hospitals, Cambridge, UK; Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK; Institute of Neuropathology, Bonn, Germany; Department of Oncology, University of Turin, Turin, Italy; Department of Radiotherapy, Royal Marsden Hospital, Surrey, UK; Department of Neuropathology, Centre Leon Berard, Lyon, France
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A Case of Nongerminomatous Germ Cell Tumor of the Pineal Region: Risks and Advantages of Biopsy by Endoscopic Approach. Case Rep Med 2018; 2018:5106701. [PMID: 29713348 PMCID: PMC5866897 DOI: 10.1155/2018/5106701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/30/2018] [Accepted: 02/15/2018] [Indexed: 01/04/2023] Open
Abstract
A 21-year-old male was admitted to our department with headache and drowsiness. CT scan and MRI revealed acute obstructive hydrocephalus caused by a pineal region mass. The serum and CSF levels of beta-human chorionic gonadotropin (beta-hCG) were 215 IU/L and 447 IU/L, respectively, while levels of alpha-fetoprotein (AFP) were normal. A germ cell tumor (GCT) was suspected, and the patient underwent endoscopic third ventriculostomy (ETV) with biopsy. After four days from surgery, the tumor bled with mass expansion and ETV stoma occlusion; thus, a ventriculoperitoneal shunt was positioned. After ten months, the tumor metastasized to the thorax and abdomen with progression of intracerebral tumor mass. Despite the aggressive nature of this tumor, ETV remains a valid approach for a pineal region mass, but in case of GCT, the risk of bleeding should be taken into account, during and after the surgical procedure.
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6
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Kohyama S, Uematsu M, Ishihara S, Shima K, Tamai S, Kusano S. An Experience of Stereotactic Radiation Therapy for Primary Intracranial Choriocarcinoma. TUMORI JOURNAL 2018; 87:162-5. [PMID: 11504371 DOI: 10.1177/030089160108700310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report on a patient with choriocarcinoma in the pineal region who was successfully treated with stereotactic radiation therapy (SRT). The increased level of serum human chorionic gonadotropin (HCG) was lowered during chemotherapy with etoposide, cisplatin, and ifosfamide. However, HCG was not normalized and magnetic resonance images still showed an enhanced tumor mass with gadolinium. The patient underwent SRT of 40 Gy at an 80% isodose line per 10 fractions over'two weeks, followed by conventional craniospinal irradiation of 32.4 Gy. The level of HCG dropped below the detection limit. The patient has been in good condition for more than four years after the completion of treatment, without any signs of recurrence. We propose SRT as a valid treatment option for malignant germ cell tumors in the pineal region.
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Affiliation(s)
- S Kohyama
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan.
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7
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Abstract
CNS germ cell tumors (GCT) are rare tumors that arise in midline brain regions (mostly pineal or suprasellar). They are of two types, germinoma and nongerminomatous GCT (NGGCT) which include teratoma, choriocarcinoma, yolk sac, embyronal carcinoma and mixed GCT. Tissue is needed for diagnosis unless serum or cerebrospinal fluid markers, b-HCG or AFP, are elevated. Germinomas can be cured with radiation therapy (RT) alone (whole ventricle fields, if localized), but chemotherapy may permit RT dose-reduction. Best outcomes for NGGCT are with RT and chemotherapy. Craniospinal RT is needed for all disseminated tumors and best survival for localized NGGCT has included craniospinal RT. Recent genetic findings in CNS GCT may lead to therapies targeting their oncogenic pathways.
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Affiliation(s)
- Patricia L Robertson
- Departments of Pediatrics & Neurology, University of Michigan Medical School, Pediatric Neuro-Oncology, 12-718 C.S. Mott Children’s Hospital, 1540 E. Hospital Dr., Ann Arbor, MI 48109, USA
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8
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Abstract
The pineal region is a complex anatomical compartment, harbouring the pineal gland surrounded by the quadrigeminal plate and the confluents of the internal cerebral veins to form the vein of Galen. The complexity of lesions in that region, however, goes far beyond the pineal parenchyma proper. Originating in the pineal gland, there are not only benign cysts but also numerous different tumour types. In addition, lesions such as tectal gliomas, tentorial meningiomas and choroid plexus papillomas arise from the surrounding structures, occupying that regions. Furthermore, the area has an affinity for metastatic lesions. Vascular lesions complete the spectrum mainly as small tectal arteriovenous malformations or cavernous haemangiomas.Taken together, there is a wide spectrum of lesions, many unique to that region, which call for a multidisciplinary approach. The limited access and anatomical complexity have generated a spectrum of anatomical approaches and raised the interest for neuroendoscopic approaches. Equally complex is the spectrum of treatment modalities such as microsurgery as the main option but stereotactic radiosurgery as an alternative or adjuvant to surgery for selected cases, radiation as for germinoma (see below) and or combinatorial chemotherapy, which may need to precede any other ablative technique as constituents.In this context, we review the current literature and our own series to obtain a snapshot sentiment of how to approach pineal lesions, how to interrelate alternative/competing concepts and review the recent technological advances.
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Affiliation(s)
- Manfred Westphal
- Department of Neurological Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany,
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Sugiyama K, Arita K, Tominaga A, Hanaya R, Taniguchi E, Okamura T, Itoh Y, Yamasaki F, Kurisu K. Morphologic features of human chorionic gonadotropin- or alpha-fetoprotein-producing germ cell tumors of the central nervous system: histological heterogeneity and surgical meaning. Brain Tumor Pathol 2012; 18:115-22. [PMID: 11908867 DOI: 10.1007/bf02479424] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Our study of germ cell tumors (GCT) of the central nervous system (CNS) investigated the relationship between tumor histology and patient serum titers of human chorionic gonadotropin (HGC) and alpha-fetoprotein (AFP). Thirty-five patients were enrolled. Their serum titers of HCG (mlU/ml) and/or AFP (ng/ml) before initial treatment were available, as were tumor specimens obtained before the administration of adjuvant therapy. They were divided into three groups, depending on whether HCG alone (group H), AFP alone (group A), or both HCG and AFP (group HA) were detected. Each group was subdivided into three groups: patients in group I had H, A, and/or HA titers below 9.9; patients in group II/III had titers from 10.0 to 999; and those in group IV had titers of 1000 or more. Serial sections of tissue specimens were repeatedly stained, mainly with hematoxylin and eosin (H-E) stain, HCG immunostain, and AFP immunostain. There were seven patients in the H-I group and five in H-II/III. Of these 12 patients, 11 had germinomas (G) and one had an embryonal carcinoma (EC). Five patients were included in group A: one was classified as A-II/III and had a germinoma, and the remaining four patients were in A-IV and had yolk sac tumors (YST) or mixed GCT consisting mainly of YST or EC (MXGCT-YST, EC). The HA group consisted of 18 patients. Three were classified as HA-I and had germinomas; nine HA-II/III patients had T or MXGCT-T; and six HA-IV patients had choriocarcinoma (CC), YST, MXGCT-CC, or MXGCT-YST. Throughout the study, the situations for the elevated serum titers could be elucidated in only four cases (three in group A-IV and one in group HA-IV). These results led to the conclusion that serologic evaluation is superior to morphologic evaluation in diagnosing marker-producing GCTs. From a diagnostic perspective, the role of surgery is to verify the HCG- and AFP-immunonegative tissue in patients with G, T, and EC.
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Affiliation(s)
- K Sugiyama
- Department of Neurosurgery, Hiroshima University Medical Hospital, Japan.
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Intracranial Germ Cell Tumors: Efficacy of Neoadjuvant Chemo-radiotherapy without Surgical Biopsy. Keio J Med 2011; 60:56-64. [DOI: 10.2302/kjm.60.56] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Brain Tumors. Neurosurgery 2010. [DOI: 10.1007/978-3-540-79565-0_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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12
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Abstract
PURPOSE Until recently, postoperative adjuvant treatment for intracranial teratomas has remained controversial because of the rarity of the tumors and the heterogeneity of histologic types. To define optimal therapy modalities, we retrospectively analyzed the treatment of patients with intracranial teratomas. METHODS Between 1979 and 2007, 31 patients with intracranial teratomas were treated at our institution. The median age of the 31 patients was 14.8 years. The median follow-up time was 72.7 months (range 11 approximately 291 months). Perioperative radiochemotherapy was done in 19 patients. Proper chemotherapy regimens were followed, such as PE (cisplatin and VP-16), PVB (cisplatin, VP-16, and bleomycin), ICE (carboplatin, VP-16, and ifosfamide), and NGGCT (etoposide, carboplatin, bleomycin, and cyclophosphamide with mesna). RESULTS Eight patients experienced recurrence, and a second operation was carried out in six patients. Fifteen patients survived for more than 5 years without recurrence, irrespective of having received adjuvant therapies. The 5-year survival rate of the 31 patients was 74%. CONCLUSION Treatment of intracranial teratomas is very difficult because of the heterogeneity of the tumor cells from totipotent origins. Accurate histological diagnosis of teratoma subtypes is the most important factor for adequate treatment, and proper therapeutic protocols are needed to cure teratomas.
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13
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Moiyadi A. Erroneous diagnosis of an intracranial growing teratoma syndrome. J Neurooncol 2009; 94:449-50. [PMID: 19347253 DOI: 10.1007/s11060-009-9883-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 03/20/2009] [Indexed: 11/29/2022]
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14
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TSUGU H, OSHIRO S, UENO Y, ABE H, KOMATSU F, SAKAMOTO S, MATSUMOTO S, NABESHIMA K, FUKUSHIMA T, INOUE T. Primary Yolk Sac Tumor Within the Lateral Ventricle -Case Report-. Neurol Med Chir (Tokyo) 2009; 49:528-31. [DOI: 10.2176/nmc.49.528] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hitoshi TSUGU
- Department of Neurosurgery, Fukuoka University Faculty of Medicine
| | - Shinya OSHIRO
- Department of Neurosurgery, Fukuoka University Faculty of Medicine
| | - Yushi UENO
- Department of Neurosurgery, Fukuoka University Faculty of Medicine
| | - Hiroshi ABE
- Department of Neurosurgery, Fukuoka University Faculty of Medicine
| | - Fuminari KOMATSU
- Department of Neurosurgery, Fukuoka University Faculty of Medicine
| | | | | | | | - Takeo FUKUSHIMA
- Department of Neurosurgery, Fukuoka University Faculty of Medicine
| | - Tooru INOUE
- Department of Neurosurgery, Fukuoka University Faculty of Medicine
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15
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Noudel R, Vinchon M, Dhellemmes P, Litré CF, Rousseaux P. Intracranial teratomas in children: the role and timing of surgical removal. J Neurosurg Pediatr 2008; 2:331-8. [PMID: 18976103 DOI: 10.3171/ped.2008.2.11.331] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT In this study, the authors report their experience with the surgical treatment of intracranial teratomas with an emphasis on the indications for delayed resection after oncological treatment. METHODS The authors retrospectively reviewed the cases of 14 children with intracranial teratomas. The mean age at diagnosis was 10.5 years (range 2 days-18 years), and 11 patients were male. The final histological analysis revealed pure mature teratoma in 5 cases, mixed teratoma with germinoma in 3 cases, and nongerminomatous malignant germ cell tumor in 6 cases. Thirteen patients underwent tumor resection, and these patients were divided into 2 subgroups according to the timing of surgery. In Group A, 10 patients underwent resection as the primary treatment because no tumor markers were detected in 4 patients, a teratomatous component was revealed on biopsy sampling in 3 patients, and a large tumor volume in 3 patients. In Group B, 3 patients underwent removal of residual pure mature teratoma after oncological treatment. RESULTS Seven of the 8 patients (87.5%) with pure mature teratomas or with mixed teratoma and germinoma are currently alive (mean follow-up of 9 years); the eighth patient died of postoperative meningitis. Two of the 6 patients (33%) with mixed nongerminomatous malignant germ cell tumors died of tumor progression regardless of the timing of surgery. CONCLUSIONS The results of this study support the belief that microsurgical removal is the only effective treatment for intracranial teratomas. Surgery may be performed as the primary therapy when there is evidence of a noninvasive teratoma, and as a secondary therapy if there is only a partial response to neoadjuvant therapy or if progression is observed in mixed malignant germ cell tumors.
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Affiliation(s)
- Rémy Noudel
- Department of Neurosurgery, Maison Blanche Hospital, University of Reims, Reims, France.
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16
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Peltier J, Vinchon M, Baroncini M, Kerdraon O, Dhellemmes P. Bifocal mixed germ-cell tumor with growing teratoma syndrome and metachronous mature metastases: case report. J Neurooncol 2008; 90:111-5. [PMID: 18574668 DOI: 10.1007/s11060-008-9640-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Accepted: 06/06/2008] [Indexed: 11/29/2022]
Abstract
The authors report the case of a 16-year-old male who presented with a bifocal diencephalic tumor arising both in the neurohypophysis and the pineal region with hydrocephalus. The histological diagnosis obtained during endoscopic ventriculocisternostomy was germinoma. MRI revealed an increase of the neoplasm during chemotherapy with recurrent obstructive hydrocephalus. A new ventriculostomy was performed followed by total surgical resection. The final histopathological analysis demonstrated an immature teratoma. Subsequently, this patient developed metachronous cystic metastases in the cerebello-pontine angles, which were resected and identified as mature teratoma, then we observed a lesion of the brachium conjunctivum which stayed stable after 29 consecutive months. The patient is alive and feels well 6 years after the initial diagnosis and 5 years after the first metastasis. To our knowledge, this is the fifth case of the growing teratoma syndrome located in the brain but the first case with simultaneously bifocal location and infratentorial disseminated metastasis. Obviously surgical removal is the treatment of reference for teratomas. Metastases of teratoma can be mature and may be amenable to surgery with a favorable outcome. Primary intracranial germ-cell tumors (CGT) arise in the midline of the brain and are located in the diencephalon. The peak incidence occurs during the second decade of life. Germ cell tumor (CGT) includes germinomas and non-germinomatous tumors, mature and immature teratomas account for 19.6 % [1]. Curiously, teratomas are able to grow during the first weeks of chemotherapy while serum markers remain normal. This situation was originally described and designed as "the growing teratoma syndroma" (GTS) in primary testis tumors by Logothetis in 1982 [2]. Here we report the rare occurrence of a GTS in a teenager who presented metachronous cystic metastases located in posterior fossa which were histologically mature.
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Affiliation(s)
- Johann Peltier
- Service de Neurochirurgie, Centre Hospitalier Universitaire d'Amiens, Place Victor Pauchet, Amiens Cedex 1, 80054, France.
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Kageji T, Nagahiro S, Matsuzaki K, Kanematsu Y, Nakatani M, Okamoto Y, Watanabe T. Successful neoadjuvant synchronous chemo- and radiotherapy for disseminated primary intracranial choriocarcinoma: case report. J Neurooncol 2007; 83:199-204. [PMID: 17205387 DOI: 10.1007/s11060-006-9311-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2006] [Accepted: 11/28/2006] [Indexed: 10/23/2022]
Abstract
We report a 17-year-old male with disseminated intracranial choriocarcinoma at the basal ganglia whose consciousness level was very low at diagnosis. He received neoadjuvant therapy (NAT) consisting of combined chemo- and radiotherapy prior to radical excision of the tumor. Postoperatively he was treated with three courses of high-dose chemotherapy (carboplatin (CBDCA), methotrexate (MTX), and etoposide (VP-16)) and peripheral blood stem-cell transplantation. This combination of therapies resulted in tumor regression on MRI and remarkable improvement in his neurological condition. Ours is the first report of the effectiveness of NAT followed by radical surgery in a patient with disseminated primary intracranial choriocarcinoma.
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Affiliation(s)
- Teruyoshi Kageji
- Department of Neurosurgery and Pediatrics, School of Medicine, The University of Tokushima, Kuramoto-cho 3-18-15, 770, Tokushima, Japan.
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Reyns N, Hayashi M, Chinot O, Manera L, Péragut JC, Blond S, Régis J. The role of Gamma Knife radiosurgery in the treatment of pineal parenchymal tumours. Acta Neurochir (Wien) 2006; 148:5-11; discussion 11. [PMID: 16172830 DOI: 10.1007/s00701-005-0626-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Accepted: 07/15/2005] [Indexed: 10/25/2022]
Abstract
OBJECT The aim of this study was to document the possible role of Gamma Knife radiosurgery, suitable for the treatment of deep and well limited tumors, in the management of pineal parenchymal tumors (PPT). POPULATION AND METHODS We reviewed retrospectively a series of 13 patients with PPT treated by Gamma Knife radiosurgery during 16 procedures. Mean age was 31 (range 10 to 74). Eight patients had pineocytomas (61.5%), and 5 had pineoblastomas (38.5%). Radiosurgery was performed alone in 6 cases, after partial microsurgical resection in 3 cases, in association with chemotherapy in 3 cases and following conventional fractionated radiotherapy in 1 case. The marginal dose to these tumors ranged from 11 to 20 Gy (mean 15 Gy). RESULTS With a mean follow-up of 34 months (range 6 to 88), all tumors responded to treatment and disappeared or ceased growing. Two patients with pineoblastoma had tumor size progression out of the initial target requiring several radiosurgery procedures. At the end of the follow-up period, 10 out of 12 patients were alive. Two patients with pineoblastoma died because of carcinomatous meningitis or tumor size progression. We observed no mortality or major morbidity related to radiosurgery. CONCLUSION This study confirms that radiosurgery can be an effective and safe primary treatment modality for patients with pineocytomas. It should have a role in multimodality therapy which includes microsurgical resection, fractionated radiotherapy and chemotherapy for the management of malignant pineal tumors.
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Affiliation(s)
- N Reyns
- Department of Neurosurgery, Centre Hospitalier Universitaire, Lille, France
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Bi WL, Bannykh SI, Baehring J. The Growing Teratoma Syndrome after Subtotal Resection of an Intracranial Nongerminomatous Germ Cell Tumor in an Adult: Case Report. Neurosurgery 2005; 56:E191-E194. [PMID: 28184632 DOI: 10.1227/01.neu.0000144847.91050.b1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2004] [Accepted: 08/27/2004] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE AND IMPORTANCE:
We report a rare complication after resection of a recurrent intracranial nongerminomatous germ cell tumor in an adult. The growing teratoma syndrome, as originally described with pediatric germ cell neoplasms, represents tumor recurrence, often cystic, that sometimes is observed after partial response to multimodality therapy and despite decreasing tumor serum markers. The enlarging tumor consists of elements of a mature teratoma that presumably are refractory to chemotherapy or radiation. To our knowledge, this is only the third case of the growing teratoma syndrome in an adult patient with nongerminomatous germ cell tumor.
CLINICAL PRESENTATION:
A 26-year-old man had signs of recurrent obstructive hydrocephalus 6 months after multimodality treatment of a diencephalic yolk sac tumor and endoscopic third ventriculostomy. Imaging studies revealed large multilocular cystic masses originating from the tumor bed and partially obstructing the ventriculostomy.
INTERVENTION:
Near total tumor resection and fenestration was performed. Histopathological analysis demonstrated a mature teratoma.
CONCLUSION:
Surgical resection, if feasible, is the treatment of choice for the growing teratoma syndrome to establish the correct diagnosis and prevent complications.
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Affiliation(s)
- Wenya Linda Bi
- Department of Neurobiology, Yale University School of Medicine, New Haven, Connecticut
| | - Serguei I Bannykh
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Joachim Baehring
- Departments of Neurology and Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
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Yagi K, Kageji T, Nagahiro S, Horiguchi H. Growing teratoma syndrome in a patient with a non-germinomatous germ cell tumor in the neurohypophysis--case report. Neurol Med Chir (Tokyo) 2004; 44:33-7. [PMID: 14959935 DOI: 10.2176/nmc.44.33] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 16-year-old woman presented with a non-germinomatous germ cell tumor in the neurohypophysis manifesting as progressive visual disturbance, amenorrhea, hydrodipsia, and polyuria. Her serum alpha-fetoprotein and human chorionic gonadotropin levels were elevated. She experienced sudden, rapid visual deterioration and underwent emergency partial tumor removal to decompress the optic nerves. Her vision subsequently improved. Histological examination of the surgical specimens confirmed immature teratoma. She received chemotherapy (ifosphamide 900 mg/m2, cisplatin 20 mg/m2, etoposide 60 mg/m2) for 5 consecutive days. Although the tumor marker levels decreased remarkably, her vision again declined rapidly due to enlargement of the tumor after the first course of chemotherapy. A second radical operation resulted in vision improvement. The tumor specimen showed only mature teratoma elements. This phenomenon, called the growing teratoma syndrome, is very rare in intracranial non-germinomatous germ cell tumors.
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Affiliation(s)
- Kenji Yagi
- Department of Neurosurgery, School of Medicine, The University of Tokushima, Tokushima, Japan
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Ogawa K, Toita T, Nakamura K, Uno T, Onishi H, Itami J, Shikama N, Saeki N, Yoshii Y, Murayama S. Treatment and prognosis of patients with intracranial nongerminomatous malignant germ cell tumors: a multiinstitutional retrospective analysis of 41 patients. Cancer 2003; 98:369-76. [PMID: 12872359 DOI: 10.1002/cncr.11495] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The relative roles of surgical resection, radiotherapy, and chemotherapy in the management of patients with intracranial nongerminomatous malignant germ cell tumors have been controversial. The authors retrospectively investigated the results of different treatment regimens in patients with these tumors. METHODS The records of 41 patients who were treated between 1981 and 2001 were reviewed. They were grouped into patients with a good prognosis (n=3), an intermediate prognosis (n=24), and a poor prognosis (n=14) based on the histology of their tumors. Fifteen patients (37%) underwent surgical resection and received radiotherapy, and 26 patients (63%) also received chemotherapy. The median follow-up of 18 patients who remained alive was 61 months (range, 14-194 months). RESULTS The 5-year actuarial overall survival rates for patients in the good prognosis, intermediate prognosis, and poor prognosis groups were 100%, 68%, and 8%, respectively. In the analysis, histology alone had a statistically significant impact on overall survival (P<0.0001). All 3 patients in the good prognosis group were treated successfully with surgical resection and radiotherapy. In the intermediate prognosis group, the 5-year actuarial overall survival rate was 44% for patients who underwent surgical resection and received radiotherapy (n=9) and 84% for patients who also received chemotherapy (n=15; P=0.01). Patients in the poor prognosis group who underwent surgical resection and received radiotherapy (n=3) or who underwent incomplete resection and received both radiotherapy and chemotherapy (n=8) all died of disease, whereas 2 of 3 patients who underwent macroscopic total resection and received both radiotherapy and chemotherapy survived free of disease. CONCLUSIONS The treatment of patients with intracranial nongerminomatous malignant germ cell tumors should be based on tumor histology. For patients who had a good prognosis (mature teratoma with germinoma), surgical resection and radiotherapy were sufficient; however, for patients in the intermediate prognosis group, multimodal treatment, including surgical resection, radiotherapy, and chemotherapy, was effective. Conversely, for patients in the poor prognosis group, more intensive multimodal treatment, including macroscopic total resection, may improve the survival rate.
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Affiliation(s)
- Kazuhiko Ogawa
- Department of Radiology, University of the Ryukyus, School of Medicine, Okinawa, Japan.
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Konovalov AN, Pitskhelauri DI. Principles of treatment of the pineal region tumors. SURGICAL NEUROLOGY 2003; 59:250-68. [PMID: 12748006 DOI: 10.1016/s0090-3019(03)00080-6] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND A pineal region tumor is an uncommon deep-seated, heterogeneous group of mass lesions of the brain, and the management strategy of any types of these tumors remains controversial. It is the purpose of this communication to present results of our experience in treating patients with these neoplasms. METHODS From 1976 to 1999 about 700 patients with tumors of the pineal region and posterior third ventricle were managed at the Burdenko Neurosurgery Institute. In more than 330 cases the tumor was removed. In this paper we present results of 287 patients with histologically verified pineal region tumors for the period from 1976 to 1999. All of them had verified tumor histology, excluding only five cases in which stereotactic biopsy procedures were uninformative. There are four main groups of tumors: the germ cell tumors-87 (31%); the pineal parenchymal tumors-75 (27%); the glial tumors-77 (27%); and miscellaneous-43 (15%). There were 255 surgical procedures for tumor removal performed in 244 and stereotactically guided biopsies in 61 patients, 168 (58%) with obstructive hydrocephalus who underwent cerebrospinal fluid shunting. Radiation therapy was administered in 145 (51%) and chemotherapy in 16 patients. Follow-up data were collected in 209 cases (80%). Survival was calculated with the Kaplan-Meier product limit method. RESULTS The occipital transtentorial and infratentorial supracerebellar approaches were the most commonly used on our series-138 (54%) and 87 (34%), respectively. In the remaining cases, subchoroidal approach, approach through the fourth ventricle, and the combined approaches were used. A total tumor removal was achieved in 148 operations (58%), subtotal in 74 (29%) and partial in 33 (13%). The projected 5-year and 10-year survival rates for patients with malignant pineal tumors, who received irradiation after tumor resection or underwent radiation therapy alone, were: 95% and 88% for pure germinomas, 80% and 50% for high grade gliomas, 44% and 0% for malignant pineal parenchymal tumors, and 20% and 0% for malignant germ cell tumors, respectively. CONCLUSIONS Benign pineal tumors should be cured with surgery alone. Malignant tumors should be treated with aggressive resection followed with irradiation and chemotherapy. Pure germinomas, which are exquisitely radiosensitive, can be cured by conventional radiation therapy alone.
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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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Nogueira K, Liberman B, Pimentel-Filho FR, Goldman J, Silva MER, Vieira JO, Buratini JA, Cukiert A. hCG-secreting pineal teratoma causing precocious puberty: report of two patients and review of the literature. J Pediatr Endocrinol Metab 2002; 15:1195-201. [PMID: 12387519 DOI: 10.1515/jpem.2002.15.8.1195] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Two boys are described with precocious puberty (PP) due to pineal immature teratoma associated with choriocarcinoma. Patient 1 was a 7 year-old boy with a 2-year history of PP. He had elevated CSF and plasma beta-hCG levels. Magnetic resonance imaging (MRI) showed a 3.0 cm pineal mass. He was initially submitted to a trial with radiotherapy, followed by radical surgical resection, stereotactic radiotherapy and chemotherapy. Long-term follow up included the appearance of acute hydrocephalus requiring CSF shunting, local hemorrhage and extensive radionecrosis. Death occurred 1.5 years after diagnosis. Patient 2 was a 7 year-old boy with an 8-month history of PP. He had elevated CSF and plasma beta-hCG and alpha-fetoprotein levels. MRI showed a 1.0 cm pineal mass. He was submitted to radical surgical resection (which caused normalization of levels of markers) and prophylactic chemotherapy. The boy is doing well 1.5 years after diagnosis. An extensive review of the literature corroborates the idea that this last treatment paradigm (surgery and chemotherapy) probably represents the best treatment regimen for these patients.
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Affiliation(s)
- Katia Nogueira
- Department of Endocrinology, Hospital Brigadeiro, São Paulo SP, Brazil
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Nishizaki T, Kajiwara K, Adachi N, Tsuha M, Nakayama H, Ohshita N, Ikeda N, Ito H, Suzuki M. Detection of craniospinal dissemination of intracranial germ cell tumours based on serum and cerebrospinal fluid levels of tumour markers. J Clin Neurosci 2001; 8:27-30. [PMID: 11322122 DOI: 10.1054/jocn.2000.0750] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nineteen intracranial germ cell tumours treated during the past 11 years were evaluated retrospectively. The tumours were classified into three groups according to the level of alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (HCG) in serum and cerebrospinal fluid, and the optimal treatment for each group was determined. Group A consisted of patients with normal titres of AFP and HCG, group B of patients with relatively high titres (< 10 times normal), and group C comprised patients with higher titres ( 10 times normal levels). In group A, an appropriate field and dose of irradiation was necessary to prevent craniospinal dissemination. In group B, none of four patients who underwent total or subtotal resection of the tumour had craniospinal disseminatio n or tumour recurrence, whereas dissemination occurred in four further patients, including two who had received radiochemotherapy only, and two who had undergone partial resection of the tumour. While patients in group C had dissemination at the time of initial diagnosis, most patients in group B developed dissemination more than 10 months after initial treatment, suggesting that the type of treatment received as first line therapy is important in patients in this group. The prognosis of patients in group C, however, was unaffected by the priority given to either surgery, radiation or chemotherapy as first line treatment. Craniospinal dissemination can be prevented in patients with germ cell tumours who have a relative increase in levels of AFP and HCG by aggressive removal of the tumours as first line therapy, regardless of the type of adjuvant therapy given.
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Affiliation(s)
- T Nishizaki
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan.
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26
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Sawamura Y, Shirato H, de Tribolet N. Recent advances in the treatment of central nervous system germ cell tumors. Adv Tech Stand Neurosurg 1999; 25:141-59. [PMID: 10370718 DOI: 10.1007/978-3-7091-6412-9_4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
- Y Sawamura
- Hôpital Cantonal Universitaire, Genève, Switzerland
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27
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Canga A, Cerezal L, Abascal F, Vázquez-Barquero A, Rodilla I, Figols J. Teratoma de la región pineal. Neurocirugia (Astur) 1999. [DOI: 10.1016/s1130-1473(99)70995-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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28
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Sawamura Y, Kato T, Ikeda J, Murata J, Tada M, Shirato H. Teratomas of the central nervous system: treatment considerations based on 34 cases. J Neurosurg 1998; 89:728-37. [PMID: 9817409 DOI: 10.3171/jns.1998.89.5.0728] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The optimum clinical management of central nervous system (CNS) teratomas, particularly postsurgical adjuvant therapy, is still unclear, partly as a result of the tumors' low incidence. In this study the authors analyze 34 cases of CNS teratomas so that they may adequately indicate management of these lesions. METHODS The median age of the 34 patients was 13 years. Twenty-seven patients treated between 1970 and 1991 were retrospectively reviewed. Four of these 27 patients died as a result of radical surgery; each of them had a teratoma involving the hypothalamus. After initial treatment, which included radiation therapy, 20 patients (48%) had died. In all seven cases of mature teratomas there was no recurrence. In two cases of immature teratomas in which there was complete surgical resection there was recurrence; however, salvage therapies were effective. Seven of eight patients with highly malignant teratomas died; for these patients salvage therapies, including repeated radiation and chemotherapy, failed. Seven patients who presented with CNS teratomas between 1992 and 1996 received adjuvant chemotherapy and radiation therapy according to a prospective study protocol. All seven patients were free from recurrence with a 70 to 100% Karnofsky Performance Scale score at a median follow-up period of 41 months. Patients with CNS teratomas rarely responded completely to chemotherapy or radiation therapy; an effective adjuvant therapy produced a partial response at best. CONCLUSIONS Because teratomas show various responses to adjuvant therapy, a misdiagnosis of their histological subtype will lead to inadequate therapy. A diverse therapeutic protocol based on histological diagnosis is necessary to plan appropriate management. Treatment recommendations are discussed in detail in the article.
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Affiliation(s)
- Y Sawamura
- Department of Neurosurgery, Hokkaido University School of Medicine, Sapporo, Japan.
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Sawamura Y, Shirato H, Ikeda J, Tada M, Ishii N, Kato T, Abe H, Fujieda K. Induction chemotherapy followed by reduced-volume radiation therapy for newly diagnosed central nervous system germinoma. J Neurosurg 1998; 88:66-72. [PMID: 9420074 DOI: 10.3171/jns.1998.88.1.0066] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECT Although curative, radiation, which is conventionally administered for germinomas, causes significant neurological sequelae. This study aimed at reducing the volume and dose of radiation to a localized level of 24 Gy by pretreating the patient with chemotherapy. METHODS Seventeen patients were divided into two risk groups based on serological findings and the extent of tumor. They were treated with chemotherapy prior to receiving localized radiation therapy. Six patients with solitary pure germinomas were treated with three or four cycles of cisplatin and etoposide (EP regimen) followed by 24-Gy local radiation therapy. Eleven patients with human chorionic gonadotropin (HCG)-secreting, multifocal, or disseminated germinomas received four to five cycles of ifosfamide, cisplatin, and etoposide (ICE regimen) followed by 24-Gy local radiation therapy. Craniospinal ports were used only in three cases of germinomas with dissemination. Gross-total resection was performed in three patients. Fourteen patients were able to be evaluated for their responses to chemotherapy. All patients achieved a complete response within three cycles. At a median follow-up duration of 24 months, 16 patients (94%) were alive without recurrence. One patient with an HCG-secreting germinoma experienced recurrence 38 months after surgery. That patient underwent successful salvage therapy using the same protocol. Thus, all 17 patients became free of disease with a 70 to 100% Karnofsky Performance Scale status. Toxicities associated with this study's chemotherapy regimen were mostly transient. No patient showed neurological or endocrinological deterioration during the follow-up period. CONCLUSIONS The EP and ICE regimens were highly effective in treating the central nervous system germinomas and permitted dose and volume reduction of the radiotherapy. Localized 24-Gy irradiation was sufficient for disease control.
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Affiliation(s)
- Y Sawamura
- Department of Neurosurgery, University of Hokkaido, School of Medicine, Sapporo, Japan.
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O'Callaghan AM, Katapodis O, Ellison DW, Theaker JM, Mead GM. The growing teratoma syndrome in a nongerminomatous germ cell tumor of the pineal gland: a case report and review. Cancer 1997; 80:942-7. [PMID: 9307195 DOI: 10.1002/(sici)1097-0142(19970901)80:5<942::aid-cncr16>3.0.co;2-w] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The growing teratoma syndrome is a recognized complication of metastatic nonseminomatous germ cell tumors of the testis and is managed surgically. It may also occur in intracranial nongerminomatous germ cell tumors. METHODS The authors performed an English language computer search using the EMBASE data base (from January 1980 to December 1996) for pineal tumors, read all abstracts, and then selected all articles pertaining to germ cell tumors at this site. RESULTS The case history of a 19-year-old male who presented with a pineal nongerminomatous germ cell tumor, which was treated with chemotherapy, is reported. Despite normalization of raised tumor marker levels, the pineal mass enlarged during chemotherapy. This was excised and proved to be a mature teratoma. A review of the literature regarding this complication of intracranial germ cell tumors is also presented. CONCLUSIONS The authors believe this to be the first reported case of growing teratoma syndrome in the pineal gland of an adult patient, two previously reported cases occurred in children. The authors conclude that the pineal gland is an unusual but important site in which to recognize the growing teratoma syndrome.
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Affiliation(s)
- A M O'Callaghan
- CRC Wessex Medical Oncology Unit, Royal South Hants Hospital, Southhampton, United Kingdom
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Sawamura Y, de Tribolet N, Ishii N, Abe H. Management of primary intracranial germinomas: diagnostic surgery or radical resection? J Neurosurg 1997; 87:262-6. [PMID: 9254091 DOI: 10.3171/jns.1997.87.2.0262] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Because intracranial germinomas are readily curable with radiation and chemotherapy or radiation therapy alone, the role of radical surgery has become debatable. This study assesses the optimum degree of surgical resection for intracranial germinomas. Twenty-nine patients who underwent surgery for germinoma were retrospectively analyzed (male/female ratio 27:2, median age 18 years). Among these 29 patients there were 10 solitary pineal, seven solitary neurohypophyseal/hypothalamic, and 12 multifocal or disseminated tumors. Biopsy samples were obtained in 16 patients (stereotactically in eight, transsphenoidally in four, and via frontotemporal craniotomy in four). Partial resection was attained in five patients (via a frontotemporal approach in three and occipitotranstentorially in two). Gross-total resection was achieved via an occipitotranstentorial route in eight patients with pineal masses. After surgery, 10 patients were treated with radiotherapy alone, and 19 received radiation and chemotherapy; complete remission was achieved in all 29 patients. The overall tumor-free survival rate was 100% at a median follow-up period of 42 months. There was no significant difference in outcome related to the extent of surgical resection. Postoperative neurological improvement was seen in only two patients, whereas transient postoperative complications, mainly upgaze palsy, were observed in six. One patient experienced a slight hemiparesis, bringing the surgical morbidity rate to 3% (one of 29). It is concluded that radical resection of intracranial germinomas offers no benefit over biopsy. The primary goal of surgery should be to obtain a sufficient volume of tumor tissue for histological examination. If there is strong evidence of germinoma on radiological studies, biopsy samples should be obtained. When a perioperative histological diagnosis of pure germinoma is made during craniotomy, no risk should be taken in continuing the resection.
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Affiliation(s)
- Y Sawamura
- Department of Neurosurgery, University of Hokkaido School of Medicine, Sapporo, Japan
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Radiation therapy for intracranial germ cell tumors: Predictive value of tumor response as evaluated by computed tomography. Int J Clin Oncol 1997. [DOI: 10.1007/bf02488875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ferrer E, Santamarta D, Garcia-Fructuoso G, Caral L, Rumià J. Neuroendoscopic management of pineal region tumours. Acta Neurochir (Wien) 1997; 139:12-20; discussion 20-1. [PMID: 9059706 DOI: 10.1007/bf01850862] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The management of pineal tumours remains controversial. During 1994 we treated four consecutive adults (16-44 yrs) harbouring a pineal tumour with a neuroendoscopic procedure. All of them presented with hydrocephalus. Pre-operative workup included cranial computerized tomography (CT), craniospinal magnetic resonance imaging (MRI) and serum levels of biological tumour markers. The endoscopic procedure consisted of a third ventriculostomy followed by biopsy with a flexible, steerable neuroendoscope. Histological diagnosis was achieved in three patients who no longer required a shunt device. Recorded complications were: bleeding during ventriculostomy that prevented us from obtaining a good sample for biopsy, short-term memory loss that cleared over a two-week period, and transient increase of pre-operative hemiparesis. Complications and morbidity are emphasized so as to be avoided with further technical experience. Neuroendoscopy affords a minimally invasive way of reaching three objectives by one-step surgery in the management of pineal region lesions: 1) CSF sample for analysis of tumour markers. 2) Treatment of hydrocephalus by third ventriculostomy. 3) Several biopsy specimens can be obtained identifying tumours which will require further open surgery or adjuvant radiation and/or chemotherapy.
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Affiliation(s)
- E Ferrer
- Department of Neurosurgery, Hospital Clinic, University of Barcelona, Spain
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Schild SE, Scheithauer BW, Haddock MG, Wong WW, Lyons MK, Marks LB, Norman MG, Burger PC. Histologically confirmed pineal tumors and other germ cell tumors of the brain. Cancer 1996; 78:2564-71. [PMID: 8952565 DOI: 10.1002/(sici)1097-0142(19961215)78:12<2564::aid-cncr16>3.0.co;2-u] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study examined the outcome of patients with histologically confirmed pineal region tumors. METHODS One hundred thirty-five patients with histologically confirmed pineal tumors and other germ cell tumors of the brain were evaluated retrospectively. The pineal parenchymal tumors (PPTs) included 15 pineoblastomas (PB), 2 mixed PPTs, 4 PPTs with intermediate differentiation, and 9 pineocytomas. The germ cell tumors included 48 germinomas, 26 mixed germ cell tumors, 11 mature teratomas, 9 immature teratomas, 6 malignant teratomas, 2 yolk sac tumors, and 3 choriocarcinomas. Patients were treated with various combinations of chemotherapy, radiotherapy, and surgery. The duration of follow-up ranged from 0.25 to 37.3 years, with a median follow-up of 5.3 years. RESULTS The 5-year patient survival rate was 86% for those with mature teratomas; 86% with pineocytomas; 80% with germinomas; 67% with immature teratomas; 49% with PPTs, excluding pineocytomas; 38% with mixed germ cell tumors; and 17% with other germ cell histologies (P = 0.0001). The delivery of > 44 Gray (Gy) to germinomas and > 50 Gy to PPTs and nongerminomatous germ cell tumors (NGGCTs) other than mature and immature teratomas was associated with improved survival. A greater extent of resection was associated with a higher rate of survival in all patients with NGGCTs. The administration of chemotherapy was associated with improved survival in those patients with NGGCTs other than mature and immature teratomas. CONCLUSIONS Prognosis was dependent on tumor type. Obtaining a tissue diagnosis made it possible to tailor therapy according to tumor type and potentially improve the survival of patients. Survival was dependent on the dose of radiation administered to patients with PPTs, germinomas, and NGGCTs other than mature and immature teratomas. More extensive resection and the use of chemotherapy were also associated with improved survival in subgroups of patients with NGGCTs. Treatment recommendations are described in detail in the article.
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Affiliation(s)
- S E Schild
- Department of Radiation Oncology, Mayo Clinic Scottsdale, Arizona 85259, USA
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CASE PROBLEMS IN NEUROLOGICAL SURGERY. Neurosurgery 1996. [DOI: 10.1097/00006123-199611000-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Schild SE, Haddock MG, Scheithauer BW, Marks LB, Norman MG, Burger PC, Wong WW, Lyons MK, Schomberg PJ. Nongerminomatous germ cell tumors of the brain. Int J Radiat Oncol Biol Phys 1996; 36:557-63. [PMID: 8948339 DOI: 10.1016/s0360-3016(96)00354-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE This analysis was performed to determine the clinical outcome of patients with primary nongerminomatous germ cell tumors of the brain. The efficacy of various treatment options was evaluated. METHODS AND MATERIALS A total of 57 patients with primary nongerminomatous germ cell tumors of the brain were identified. Patient-related data were collected and analyzed retrospectively. Follow-up in surviving patients ranged from 3 to 243 months (median follow-up 36). Survival and failure rates were determined using the Kaplan-Meier method, and differences between the survival curves were evaluated using either the log rank test or the Wilcoxon test. RESULTS The 3-year survival rate was 86% for patients with mature teratomas, 67% for patients with immature teratomas, 44% for patients with mixed germ cell tumors, and 13% for patients with the other histologic types (p = 0.02). The 3-year survival rate was 0% for patients having biopsies alone, 32% for patients having subtotal resections, and 73% for patients having gross total resections (p = 0.0001). Patients with tumors other than mature or immature teratomas were evaluated for possible relationships between the administration of chemotherapy or radiotherapy and survival. Patients who received chemotherapy had a 3-year survival rate of 56% compared to 8% for those patients who did not receive chemotherapy (p = 0.0001) Patients who received radiotherapy had a 3-year survival rate of 46% compared to 11% for those patients who did not receive radiotherapy (p = 0.0015). CONCLUSION The survival of patients with primary nongerminomatous germ cell tumors of the brain is dependent on tumor histology and the extent of surgical resection. Patients with tumors other than mature or immature teratomas appear to benefit from the administration of chemotherapy and radiotherapy.
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Affiliation(s)
- S E Schild
- Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ 85259, USA
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Kreth FW, Schätz CR, Pagenstecher A, Faist M, Volk B, Ostertag CB. Stereotactic management of lesions of the pineal region. Neurosurgery 1996; 39:280-9; discussion 289-91. [PMID: 8832665 DOI: 10.1097/00006123-199608000-00010] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE The relevance of the computed tomography-guided stereotactic approach for the management of lesions of the pineal region is analyzed. METHODS In a retrospective analysis conducted between 1985 and 1993, the risk profile, the diagnostic accuracy, and the therapeutic relevance of the stereotactic approach in 106 patients was studied. Survival analysis was used to assess the reliability of the stereotactically obtained diagnosis in terms of follow-up observation. RESULTS A histological diagnosis was obtained in 103 of the 106 patients. In three patients, a conclusive diagnosis could not be established because of intraoperative complications. One lesion was misdiagnosed as a pineocytoma instead of a pineoblastoma. Two of the 106 patients died; 9 patients experienced perioperative morbidity. In 38 patients, the stereotactic approach was also useful for therapy. Cyst aspiration and/or internal drainage was performed in 18 patients with symptomatic cystic lesions, and radiosurgical treatment with use of interstitial 125iodine was performed in 16 patients with low-grade tumors and in 4 patients with solitary metastases. In 12 patients, the obtained tissue diagnosis was the basis for deferring additional therapy. In 43 patients with germ-cell tumors, pineoblastomas, or malignant gliomas, a stereotactic biopsy was the starting point for additional radiotherapy/chemotherapy. Open tumor resection played a minor role (five patients). CONCLUSION The stereotactic approach to the pineal region is a relatively safe procedure in experienced hands. The diagnosis obtained by computed tomography-guided stereotactic biopsy is a valid basis for treatment decisions. Long-term follow-up observation of the benign lesions is necessary for a definite confirmation of diagnostic accuracy.
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Affiliation(s)
- F W Kreth
- Department of Stereotactic Neurosurgery, University of Freiburg, Germany
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Schut L, Stieg PE, Scott RM, Barnes PD, Folkerth RD. CASE PROBLEMS IN NEUROLOGICAL SURGERY. Neurosurgery 1996. [DOI: 10.1227/00006123-199604000-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Louis Schut
- Children's Hospital of Pennsylvania Philadelphia, Pennsylvania
| | - Philip E. Stieg
- Children's Hospital of Pennsylvania Philadelphia, Pennsylvania
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Schut L. Management of a pediatric hypothalamic mass. Neurosurgery 1996; 38:806-11. [PMID: 8692402 DOI: 10.1097/00006123-199604000-00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- L Schut
- Children's Hospital of Pennsylvania, Philadelphia, USA
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Haupt C, Ancker U, Muller M, Herrmann HD, Schulte FJ. Intracranial germ-cell tumours--treatment results and residuals. Eur J Pediatr 1996; 155:230-6. [PMID: 8929734 DOI: 10.1007/bf01953944] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED There is only sparse information about the development of children after successful treatment for intracranial germ-cell tumours. Between January 1981 and June 1992, 26 children with intracranial germ-cell tumours were treated in the University Hospital Hamburg-Eppendorf. We report on treatment results, long standing residuals and the "quality of life" of these patients. The long-term event-free survival was 88% for the germinomas and 43% for the malignant teratomas. Of the patients 58% had no relevant functional neurological deficits and 37% had mild impairment. Only 1 patient with metastatic disease was severely handicapped. Six patients showed neuro-endocrine dysfunction. All of them had suprasellar/hypothalamic lesions and all received successful substitution therapy. As to neuropsychological functions, 53% of the patients had no or only mild disturbances. The most affected function was speed of information processing. Of the children 69% were able to proceed with their education at the same level as before therapy. The overall self-assessment revealed good results in 75% of the patients. CONCLUSION After surgical removal and radiation therapy long-term survival of intracranial germinomas amounts to 88%. Despite craniospinal axis radiation severe residuals are rare and a good quality of life is common. In malignant teratomas treatment regimens including chemotherapy are much less successful.
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Affiliation(s)
- C Haupt
- Departments of Paediatrics and Neurosurgery, University Hospital Hamburg-Eppendorf, Germany
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