[Recurrence of intracranial germinoma initially treated with chemotherapy only]

Irradiation for intracranial germinoma may be associated with significant neuroendocrinological sequelae, so the establishment of lower effective doses of radiation is desirable. Eight consecutive patients with intracranial germinoma underwent combination chemotherapy with BEP (bleomycin, etoposide, and cisplatin) or PE (cisplatin and etoposide) without irradiation between 1996 and 1997. The diagnosis was based on endoscopic or stereotactic biopsy, or transsphenoidal surgery in 7 cases. These 7 patients obtained complete response (CR) after treatment with chemotherapy only. The diagnosis of pure germinoma was based on neuroradiographic appearances and the normal levels of tumor markers in patients with suprasellar and pineal-region germ cell tumors. Although all patients obtained CR, 5 patients relapsed at a mean period of 19 months after the initial therapy. The mean follow-up period was 53 months. Two of these 5 patients had recurrence around the ventricle wall. Additional chemotherapy and total ventricle irradiation (24 Gy) achieved CR, but delayed seeding in the optic nerves outside the irradiated field was detected. One patient suffered peritoneal dissemination via a ventriculoperitoneal shunt with intracranial dissemination. Another patient obtained CR after PE therapy, but there was not histological verification. However, 35 months after the initial therapy, surgical extirpation of the recurrent tumor revealed immature teratoma. One patient refused treatment for recurrence at the initial tumor site and died 42 months after the initial treatment. Adequate initial therapy is absolutely essential for the treatment of intracranial germinoma. The chemotherapy regimens in use today cannot be recommended as initial therapy without irradiation because of the high recurrence rates.