Craniospinal radiation in the treatment of biopsy-proven intracranial germinomas: twenty-five years' experience in a single center

Maity, Amit; Shu, Hui; Janss, Anna J.; Belasco, Jean B.; Rorke, Lucy B.; Phillips, Peter C.B.; Sutton, Leslie N.; Goldwein, Joel W.

doi:10.1016/j.ijrobp.2003.08.028

Cited by 106 publications

(56 citation statements)

References 26 publications

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“…1 Intracranial germinomas are highly radiosensitive, with a tendency to spread via cerebrospinal fluid (CSF), and systemic craniospinal radiation therapy has been the standard treatment for many decades. 2,3 With this treatment approach, the majority of patients have been cured. 4 Concerns have long been raised about the potential adverse effects of radiotherapy.…”

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confidence: 99%

SIOP CNS GCT 96: final report of outcome of a prospective, multinational nonrandomized trial for children and adults with intracranial germinoma, comparing craniospinal irradiation alone with chemotherapy followed by focal primary site irradiation for patients with localized disease

et al. 2013

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Background. We conducted a nonrandomized international study for intracranial germinoma that compared chemotherapy followed by local radiotherapy with reduced-dose craniospinal irradiation (CSI) alone, to determine whether the combined treatment regimen produced equivalent outcome and avoided irradiation beyond the primary tumor site(s). Methods. Patients with localized germinoma received either CSI or 2 courses of carboplatin and etoposide alternating with etoposide and ifosfamide, followed by local radiotherapy. Metastatic patients received CSI with focal boosts to primary tumor and metastatic sites, with the option to be preceded with chemotherapy. Results. Patients with localized germinoma (n ¼ 190) received either CSI alone (n ¼ 125) or combined therapy (n ¼ 65), demonstrating no differences in 5-year event-free or overall survival, but a difference in progression-free survival (0.97 + 0.02 vs 0.88 + 0.04; P ¼ .04). Seven of 65 patients receiving combined treatment experienced relapse (6 with ventricular recurrence outside the primary radiotherapy field), and only 4 of 125 patients treated with CSI alone experienced relapse (all at the primary tumor site). Metastatic patients (n ¼ 45) had 0.98 + 0.023 event-free and overall survival. Conclusions. Localized germinoma can be treated with reduced dose CSI alone or with chemotherapy and reduced-field radiotherapy. The pattern of relapse suggests inclusion of ventricles in the radiation field. G erminomas contribute to about 60% of all intracranial germ cell tumors located in the pineal gland, suprasellar region, basal ganglia, and hypothalamus.1 Intracranial germinomas are highly radiosensitive, with a tendency to spread via cerebrospinal fluid (CSF), and systemic craniospinal radiation therapy has been the standard treatment for many decades.2,3 With this treatment approach, the majority of patients have been cured. 4 Concerns have long been raised about the potential adverse effects of radiotherapy.4 -6 Therefore, other treatment approaches were introduced to evaluate craniospinal irradiation alone, but with reduced doses, compared with previous practice, or chemotherapy either in combination with radiotherapy or alone. 7,8 In the German MAKEI 89 trial, 30 Gy were applied to the craniospinal axis (CSI) with an additional tumor boost of 15 Gy. 9 With this regimen, 88% of the patients remained relapse-free at 5 years. In 1990, the French Society of Paediatric Oncology initiated a trial using chemotherapy and local field radiotherapy in localized germinomas with favorable results. 10 In 1998, Matsutani et al 11,12 reported excellent survival for germinomas treated with surgery, followed by extended field or whole brain radiotherapy. Patients who received chemotherapy before reduced radiotherapy (30 Gy) were all alive at a median follow-up of 4.3 years. Aoyama et al 13 presented promising excellent results in a second Japanese series including 16 germinomas treated with surgery, followed by chemotherapy and low-dose involved-field radiotherapy. Approaches using c...

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SIOP CNS GCT 96: final report of outcome of a prospective, multinational nonrandomized trial for children and adults with intracranial germinoma, comparing craniospinal irradiation alone with chemotherapy followed by focal primary site irradiation for patients with localized disease

et al. 2013

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“…2,4,8,13 Tissue diagnosis can be made either stereotactic or endoscopic biopsy or open surgical proce dure. 1,2,4,8,13,15,17,19,20,22,23,26,28,31,32 These days, due to advancement in neurosurgical techniques combined with neuroanesthesia and postoperative critical care methods have made aggressive surgical resection, a mainstay of management. So, complete tumor removal has been clearly established an optional treatment for pineal tumors.…”

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confidence: 99%

Our Experience with Infratentorial Supracerebellar (ITSC) Approach for Pineal Region Tumor Excision

et al. 2016

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P ineal region tumors are rare, accounting for less than 1% of all primary CNS tumors, with somewhat higher percentages in Japanese population. Pineal tumors are common in children and young adult. 2,13Tumors of pineal region represent a diverse collection of tumors which may involve not only pineal gland itself but also posterior portion of the third ventricle, tectum and aqueduct of mid brain. 13 There are four groups of tumors

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“…Although the risk of tumor spillage into the subarachnoid spaces is inevitable, surgical biopsy has been part of the management of pineal geminoma in many centers in the world [11][12][13] . Based on their experiences with the Children's Cancer Study Group, Wara et al [7] reported an incidence of spinal metastases in 14% of patients with biopsy-proven pineal germinoma and 1.7% in the nonbiopsy group.…”

Section: Discussionmentioning

confidence: 99%

“…Cisplatin multidrug combination therapy can be the treatment of choice for both primary and recurrent ger- [11] 39C RT (LI + CSI) 10 years, 98% B = Bleomycin; C = children; Ch = chemotherapy; CSI = craniospinal irradiation; E = etoposide; LI = local irradiation; P = cisplatin; RT = radiotherapy; V = vinblastine. minoma [10] .…”

Section: Discussionmentioning

confidence: 99%

Dual Occurrence of Pineal Germinoma and Testicular Seminoma

Ho¹

2005

Pediatr Neurosurg

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A 16-year-old male presented with obstructive hydrocephalus secondary to pineal germinoma. There have been many reported cases of abdominal metastasis of pineal germinoma after ventriculoperitoneal shunting. Endoscopic ventriculostomy was preferred in our case, thus avoiding iatrogenic peritoneal seeding, but spinal metastasis was unavoidable. Metastatic infiltration of the ventricular system and spinal meninges is the commonest mode of spread. Later, the patient underwent orchidectomy for an asymptomatic left testicular seminoma. He responded to chemotherapy, and had a complete recurrence-free remission for more than 10 years. As far as we know there are only a handful of reported cases of dual occurrence of two primary germ cell tumors (GCT), i.e. gonadal seminoma and pineal germinoma with spinal seeding. We also addressed the controversial subject of radiation versus chemotherapy in the management of patients with pineal germinomas. A review of the relevant literature and recommendations for future treatment of similar cases are discussed.

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Craniospinal radiation in the treatment of biopsy-proven intracranial germinomas: twenty-five years' experience in a single center

Cited by 106 publications

References 26 publications

SIOP CNS GCT 96: final report of outcome of a prospective, multinational nonrandomized trial for children and adults with intracranial germinoma, comparing craniospinal irradiation alone with chemotherapy followed by focal primary site irradiation for patients with localized disease

SIOP CNS GCT 96: final report of outcome of a prospective, multinational nonrandomized trial for children and adults with intracranial germinoma, comparing craniospinal irradiation alone with chemotherapy followed by focal primary site irradiation for patients with localized disease

Our Experience with Infratentorial Supracerebellar (ITSC) Approach for Pineal Region Tumor Excision

Dual Occurrence of Pineal Germinoma and Testicular Seminoma

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