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Published on: November 20, 2012
Intracranial germinoma: report of seven cases
B Jereb1, N Zupancic, J Petric
1Institute of Oncology, Ljubljana, Slovenia, Yugoslavia.
Insights
This study shows that chemotherapy before radiation therapy can lead to total disappearance of intracranial germinomas in children. Lower radiation doses to the tumor bed are sufficient for localized germinoma control.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Radiation Oncology
Background:
- Intracranial germinomas are rare tumors affecting children and adolescents.
- Treatment strategies have evolved, necessitating review of historical data.
- Understanding optimal treatment is crucial for improving patient outcomes.
Purpose of the Study:
- To review the outcomes of children treated for intracranial germinomas between 1983-1987.
- To evaluate the efficacy of combined chemotherapy and radiation therapy.
- To determine if lower radiation doses are effective for localized disease.
Main Methods:
- Retrospective review of seven pediatric patients with intracranial germinomas.
- Analysis of treatment modalities including surgery, chemotherapy (cyclophosphamide), and radiation therapy.
- Assessment of tumor response and patient survival.
Main Results:
- All seven patients survived and were reported as well.
- Three patients achieved total tumor disappearance following chemotherapy prior to radiation.
- Localized germinomas were successfully controlled with lower radiation doses (30-40 Gy) to the tumor bed only.
Conclusions:
- Combined modality treatment, including chemotherapy, is effective for pediatric intracranial germinomas.
- Neoadjuvant chemotherapy can lead to complete tumor regression.
- Localized disease may be managed with reduced radiation doses, sparing patients from excessive toxicity.
Abstract:
Seven children with histologically verified intracranial germinomas, treated between 1983-1987, are reviewed. The four boys were 12, 14, 15, and 16 years old; two girls were 9, and one girl was 10 years old. Four tumors were suprasellar, and three were in the pineal region. Parinaud's sign was the first symptom in the pineal tumors and diabetes insipidus in the suprasellar ones. The latter four patients also had pituitary deficiencies. The tumors were totally removed in three patients, partially in three, and one patient had biopsy only. Two patients had disseminated tumor. All patients received radiation: four to the tumor bed, one to the whole brain, and two to the whole central nervous axis (CNA). The doses to the tumor were 30 Gy in three, 40 Gy in two (one whole brain), and 45 Gy in two. The dose to the CNA was 24 Gy. Five patients had chemotherapy as well: cyclophosphamid (cytoxan) 80 mg/kg in two doses, three times in 3-week intervals. All patients are alive and well. Total disappearance of tumor followed chemotherapy before radiation in three patients. Lower doses of radiation (30 Gy, 40 Gy) and irradiation of the tumor bed only were sufficient for tumor control in localized germinoma.
