Radiotherapy for tumours of the pineal region and suprasellar germinomas

Between 1960 and 1985, 42 patients with pineal region tumours and two patients with suprasellar germinomas were treated by irradiation after shunting with biopsy in five cases and subtotal resection in three cases. Ten year survival rates are: 79% in patients less than 31 years old and unbiopsied tumours, 25% in patients older than 30 years and unbiopsied tumours, 3/4 in patients with germinomas. Target volumes varied, but only three cases had craniospinal irradiation. Cumulative risk of spinal seeding in patients with germinomas and unbiopsied tumours is about 6% after cranial radiotherapy. The low risk of spinal seeding in patients with pineal tumours of unknown histology or germinomas without signs of dissemination in the CT/MR, myelography, examination of the CSF (cytology and markers) do not justify prophylactic spinal irradiation. Our data do not show a clear association between cranial target volume (whole brain or local fields) and recurrence rate. 41 of 44 cases had target doses higher than 4400 cGy. There is a small but definite risk of major complications after a dose of about 5500 cGy with conventional fractionation.