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Published on: October 27, 2014
Limited-field radiation for bifocal germinoma
Lucie Lafay-Cousin1, Barbara-Ann Millar, Donald Mabbott
1Pediatric Brain Tumor Program, Hospital for Sick Children, Toronto, Ontario, Canada. lucie.lafay-cousin@sickkids.ca
Summary
Bifocal germinomas, rare brain tumors, show excellent outcomes with chemotherapy and focal radiation. This treatment approach suggests bifocal germinoma is locoregional, not metastatic.
Area of Science:
- Neuro-oncology
- Pediatric oncology
- Radiation oncology
Background:
- Bifocal germinomas involving the pineal and neurohypophyseal regions are rare.
- Optimal treatment strategies require further investigation.
Purpose of the Study:
- To evaluate the outcomes of bifocal germinomas treated with chemotherapy followed by focal radiation.
- To characterize the incidence, presentation, and treatment of these tumors.
Main Methods:
- Retrospective review of 6 patients diagnosed with bifocal germinoma between 1995 and 2004.
- Inclusion criteria included specific MRI findings, negative spinal imaging, CSF cytology, and tumor markers.
- Patients received chemotherapy followed by limited-field radiation therapy.
Main Results:
- All 6 patients achieved complete remission after chemotherapy.
- Median follow-up was 48.1 months, with all patients remaining in remission.
- Symptoms of diabetes insipidus were common at presentation.
Conclusions:
- Bifocal germinoma may be considered a locoregional disease.
- Chemotherapy and focal radiotherapy appear sufficient for excellent outcomes.
- Improved staging may increase the reported incidence of this entity.
