A retrospective study: multiply recurrent intracranial germ cell tumors

Intracranial germ cell tumors (GCTs) are a rare group of malignancies that are prone to recurrence and dissemination. The management of patients with multiple recurrent GCTs is particularly challenging. This study aimed to summarize the clinical characteristics of intracranial GCTs with multiple recurrences (≥3 times) and to provide a basis for improving prognosis.

We collected clinical data from patients with multiply recurrent (≥3 times) intracranial GCTs treated at Sanbo Brain Hospital between 2016 and 2023. Data included sex, age, histological diagnosis, number of recurrences, tumor location, treatment regimens, and survival outcomes. Treatment modalities at initial diagnosis and each recurrence were recorded. Progression-free survival (PFS) intervals between recurrences were compared, and overall survival (OS) was analyzed.

A total of 49 patients were included: 13 with pure germinomas and 36 with non-germinomatous germ cell tumors (NGGCTs). The cohort included 39 (79.6%) males and 10 (20.4%) females, with a mean age at initial presentation of 13.29 ± 5.99 years. The number of recurrences ranged from 3 to 11. Overall survival of germinoma patients was significantly better than that of NGGCT patients (P = 0.0019). For both germinomas and NGGCTs, the PFS interval between first and second recurrences (PFS2) was significantly shorter than that from initial diagnosis to first recurrence (PFS1) (P = 0.0286 and P = 0.0428, respectively). The Friedman test demonstrated significant shortening of PFS intervals with successive recurrences in both germinomas (P<0.0001) and NGGCTs (P = 0.0092).

For patients with multiply recurrent GCTs, management increasingly relies on systemic chemotherapy as local modalities become less feasible. In addition, the interval between recurrences shortens with successive relapses, with the time to the second recurrence being significantly shorter than that to the first in both germinomas and NGGCTs.