Factors affecting functional prognosis in survivors of primary central nervous system germinal tumors

We evaluated 79 patients of whom 62 survived treatment for intracranial germinal tumors between 1964 and 1992. The survivors were assessed for their Karnofsky scores and intellectual and reproductive functions to verify factors associated with better prognosis. Thirty-one tumors were pineal, 17 were suprasellar, and ten were in the basal ganglia. These included 50 germinomas, five teratomas, and seven tumors of extra-embryonic origin producing alpha-fetoprotein or human chorionic gonadotropin. Although patients with germinoma or benign teratoma had better Kaplan-Meier survival rates than those with extra-embryonic origin tumors, the mean Karnofsky scores of the survivors did not differ significantly among the three histologic groups. On the other hand, although survival rates did not differ significantly among different tumor site groups, the mean Karnofsky score of the pineal group was higher than that of the suprasellar or basal ganglia group. Intellectual and reproductive functions were severely affected in the basal ganglia and suprasellar tumor groups, respectively. The Karnofsky score of survivors treated after 1977 was higher than for those treated before 1977. The score of patients who received less than 55 Gy irradiation was better than those who received more than 55 Gy. No patient who received less than 45 Gy developed a recurrence, suggesting that a lower dose may suffice for pure germinomas. Tumors of extra-embryonic origin, however, should be treated with combined chemotherapy to minimize subsequent irradiation. Factors affecting survivors' capabilities are discussed.