Midline Pineal Tumors and Suprasellar Germinomas: Highly Curable by Irradiation

Abstract

Sixty-one patients with midline pineal tumors and 16 patients with suprasellar germinomas were treated with surgical decompression and relatively high-dose radiotherapy of the primary site. Results were excellent, and there were no long-term complications. Ten per cent of midline pineal tumors and 37% of suprasellar germinomas metastasized to the cerebral or spinal subarachnoid space within 6 months to 5 years. Irradiation of the entire neural axis is recommended for locally extensive tumors, simultaneous pineal and hypothalamic lesions, and all biopsy-proved germinomas. The five-year survival rate was 79% for midline pineal tumors and 77% for suprasellar germinomas.

Lack of benefit of spinal irradiation in the primary treatment of intracranial germinoma

“…Previous reports showed that radiation doses Ͻ 50 Gy were associated with high local recurrence. 25,26 However, these cases of recurrence were treated about 30 years ago, when the quality of radiotherapy was not as good as the current standard. Dattoli and other investigators reported that some patients who received low-dose radiotherapy (Ͻ 40 Gy) developed local recurrence.…”

Combined treatment modality for intracranial germinomas: results of a multicentre SFOP experience

“…However, this treatment was developed at a time when staging procedures were limited, and it was therefore a safe option for unstaged patients. With modern imaging procedures, the proportion of patients presenting with metastatic disease at the time of diagnosis is low, and the risk of secondary spinal seeding in germinoma does not exceed 15% in large series (Sung et al, 1978;Linstadt et al, 1988;Matsumani et al, 1997). Furthermore, in a review of the literature, Brada et al (1990) have shown that the incidence of secondary seeding did not differ between patients treated with craniospinal radiotherapy and whole brain radiotherapy.…”

Germinoma With Syncytiotrophoblastic Giant Cells Recurring 13 Years After Radiotherapy for a Pineal Germinoma. Case Report.

“…3,11,13,15) The prognosis for intracranial germinomas with STGC that are treated adequately with radiation therapy does not differ from that of pure germinomas. 12) However, the recurrence rate ranges from 13% to 50%.…”

“…3,4,7,11,13,16) Germinomas occasionally recur more than 10 years after initial radiation therapy, including postoperative radiation therapy 4,10) and germinomas with STGC tend to recur later than pure germinomas. 11) This recurrence may be related to the field of irradiation rather than the dose, 8,13,16) suggesting the need for prophylactic irradiation of the whole spinal axis, 8,11,13,15) as eight of 22 patients (36.4%) suffered spinal metastasis. 13) The possibility of a relationship between direct surgery and spinal dissemination was proposed before the concept of germinoma with STGC was established.…”

“…11) This recurrence may be related to the field of irradiation rather than the dose, 8,13,16) suggesting the need for prophylactic irradiation of the whole spinal axis, 8,11,13,15) as eight of 22 patients (36.4%) suffered spinal metastasis. 13) The possibility of a relationship between direct surgery and spinal dissemination was proposed before the concept of germinoma with STGC was established. 11,15) Germinomas with STGC have a worse prognosis than pure germinomas and occasionally recur late, so the initial treatment should consist of both radiation therapy and chemotherapy to prevent CSF dissemination and late recurrence.…”