Long-term follow-up and quality of life in patients with intracranial germinoma

Abstract

Intracranial germinomas are fairly rare tumors occurring mostly in children or young adults with a comparatively good prognosis. Radiation is the preferred treatment of choice for this diagnosis. It has been thoroughly studied to what extent radiation doses and fields can be limited in order to avoid side effects in these young patients. The role of chemotherapy remains unclear, whereas surgery is limited to biopsy for proof of histology. Regarding the good overall survival rate, quality of life is a significant aspect to consider in these patients. We present a single institution analysis of patients with intracranial germinoma and analyze the long-term outcome with special regard to quality of life. Thirty-three patients with intracranial germinomas were analyzed by chart review, telephone interview, and neurological assessment. Additionally, a survey on quality of life was performed. The 10-year overall survival rate was 82.1 % at a mean follow-up of 141 (22-306) months. Three quarters (76 %) of the patients reached a favorable neurological outcome on the Modified Rankin Scale (mRS 0-2). However, the self-reported quality of life was significantly worse in germinoma patients compared with a healthy control group (p < 0.001). Surgical resection of the tumor led to no improvement regarding overall survival, neurological outcome, and quality of life. In terms of cognitive functioning, patients with tumor resection were significantly more impaired than biopsied patients (p = 0.04). Although germinomas are efficiently treatable tumors, the restrictions in quality of life in these often young patients are considerable, including financial difficulties. There seems no justification for tumor resection in newly diagnosed cases suspicious for germinoma as the cognitive outcome is worse than in biopsied patients, and there is no effect on overall survival.

High‐dose chemotherapy with autologous stem cell transplantation spares re‐irradiation for recurrent intracranial germinoma

“…Patients with intracranial germinoma often face significant late adverse effects because of the location of the primary tumor and its treatment . In addition, HDC is closely associated with late adverse effects, such as infertility and secondary malignancies .…”

“…The majority of recurrent intracranial germinomas remain sensitive to chemotherapy and radiotherapy; however, re‐irradiation in a previously irradiated field is often difficult to perform due to the potential risk of severe toxicities, such as stroke, neurological and neurocognitive impairments, and secondary malignancies . Previous reports show that high‐dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) is a promising therapy for recurrent intracranial germinoma; however, these reports do not fully address the potential for avoidance of re‐irradiation in patients receiving HDC.…”

“…1 The majority of recurrent intracranial germinomas remain sensitive to chemotherapy and radiotherapy [2][3][4] ; however, re-irradiation in a previously irradiated field is often difficult to perform due to the potential risk of severe toxicities, such as stroke, neurological and neurocognitive impairments, and secondary malignancies. [5][6][7] Previous reports show that high-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) is a promising therapy for recurrent intracranial germinoma [8][9][10][11] ; however, these reports do not fully address the potential for avoidance of re-irradiation in patients receiving HDC. In this study, the clinical outcome of HDC was Abbreviations: ASCT, autologous stem cell transplantation; CR, complete remission; HDC, high-dose chemotherapy; ICE, ifosfamide-carboplatin-etoposide; MEC, melphalan-etoposide-carboplatin; MEL, melphalan retrospectively analyzed in six patients with recurrent intracranial germinoma, including four patients who achieved long-term survival without re-irradiation.…”

A 42‐Year‐Old Male with Diabetes Insipidus

“…As the tissue specimen may not be representative, evaluation of the cerebrospinal fluid and serum for alpha‐fetoprotein (AFP), beta‐human chorionic gonadotropin (HCGβ) and human placental alkaline phosphatase (hPLAP) can have additional benefit for further differentiation (8). The most common treatment of germinomas is radiotherapy . The prognosis of germinoma is good, reporting a 90% 5‐year survival rate.…”

MRI and MR spectroscopy findings of the evolution of an intracranial germinoma: A case report

“…Radiotherapy is associated with a good prognosis, with a 10-year overall survival rate of 82.1% (4).…”