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Pineal tumors
1Harvard Medical School, Massachusetts General Hospital, Boston.
Abstract:
From 1972-1985, 30 patients with pineal area tumor have been treated with combinations of surgery and irradiation, no patient receiving chemotherapy as a primary recommendation. Patients ranged between 3 and 69 years of age, 18 were male and 12 female. In 18 patients a tissue diagnosis was made initially, 14 patients required shunts before definitive management and in 8 of the 14 tissue diagnosis was made at the same time. Eight patients had no surgical intervention at any time. Patients who have received irradiation have had whole brain irradiation, local field irradiation, or craniospinal irradiation. Two elderly patients died rapidly of their malignant processes before definitive treatment could be given. Only one patient with a non neoplastic lesion was seen. This was a bleed from an AVM with no underlying tumor. One patient with a pineocytoma was not irradiated. Overall, two-thirds of our patients are alive 5 to 15 years after treatment. There has been no surgical mortality and minimal morbidity from biopsy. Late effects of treatment include one patient with mild hearing loss and three patients with endocrinopathies amenable to medical treatment. We believe that tissue diagnosis allows optimal field design and dose recommendations to be made by the radiotherapist in addition to defining prognosis. In our experience, endodermal sinus tumor and pineoblastoma are highly malignant, and in view of their poor prognosis with conventional management consideration of more radical treatment with a possible role for chemotherapy is suggested.
Insights
Pineal area tumors in 30 patients were treated with surgery and irradiation, achieving a two-thirds survival rate 5-15 years post-treatment. Tissue diagnosis is crucial for optimal management and prognosis of these rare tumors.
Area of Science:
- Neuro-oncology
- Radiation Oncology
- Pediatric Oncology
Background:
- Pineal area tumors are rare and diverse, posing diagnostic and therapeutic challenges.
- Treatment strategies have evolved, with surgery and irradiation being primary modalities.
Purpose of the Study:
- To evaluate the outcomes of surgical and irradiation-based treatment for pineal area tumors.
- To emphasize the importance of tissue diagnosis in guiding treatment and predicting prognosis.
Main Methods:
- Retrospective analysis of 30 patients treated between 1972-1985.
- Combination of surgery, whole brain, local field, or craniospinal irradiation.
- Tissue diagnosis was obtained in 18 patients; 14 required shunts.
Main Results:
- Two-thirds of patients survived 5 to 15 years post-treatment.
- No surgical mortality and minimal morbidity from biopsy.
- Late effects included mild hearing loss and treatable endocrinopathies.
Conclusions:
- Tissue diagnosis is essential for optimal treatment planning and prognostic assessment.
- Endodermal sinus tumors and pineoblastomas exhibit high malignancy, warranting consideration of aggressive therapies, potentially including chemotherapy.