Pinealoma (Germinoma) Treated by Direct Surgery and Postoperative Irradiation

Abstract

60 cases of histologically verified pinealoma of the two-cell-pattern type (the so-called germinoma) experienced from 1962 to 1979 were submitted to direct surgery (by occipital transtentorial approach or infratentorial supracerebellar approach in case of tumors in the pineal region and subfrontal approach in cases of suprasellar tumors) and postoperative irradiation. Locations of tumors were 32 in the pineal region, 20 in the suprasellar region, and 8 in other areas. There was no operative mortality. The postoperative survival rates (the observed survival rates) of these cases were as follows: the 1-year survival rate (1 YSR) was 94.8%, the 5-year survival rate (5 YSR) was 74.8% and 10-year survival rate (10 YSR) was 69.3%. As for pinealomas in the pineal region, 1 YSR was 93.5%, 5 YSR was 64.7% and 10 YSR was 60.1 %; for tumors in the suprasellar region, 1 YSR was 100%, 5 YSR was 100% and 10 YSR was 92.3%. In cases aged from 15 years up, 1 YSR was 93.7%, 5 YSR was 65.0% and 10 YSR was 60.2%, and in cases under 15 years (children), 1 YSR was 95.1%, 5 YSR was 86.9% and 10 YSR was 86.9%. Thus, the results were much better in suprasellar germinoma cases than in pineal cases and in children than in adolescents and adults. Suprasellar germinoma cases under 15 years showed 100%in 1 YSR, 5 YSR and 10 YSR. The reason for this is probably that surgical removal of tumors or reduction of the bulk of tumors may be easier or more extensive in suprasellar germinomas than in pineal germinomas. Among these 60 cases, 2 died of recurrence of tumor, 3 died of dissemination metastases in the cerebrospinal fluid space and the other 11 died of other diseases or due to unknown cause. Besides these 60 cases, 10 cases of probable pinealomas (germinomas) were treated by irradiation without direct surgery. Among these, 1 case died 3 years and 1 month later and 1 case had recurrence and was irradiated again. Most of these cases were experienced in the past 2 years and the follow-up was not long enough. All these cases had rather small tumors, single or multiple. The histogenesis of the tumor and the causes of its radiosensitivity are discussed.

Effects of Therapy on Anterior Pituitary Functions in Patients with Primary Intracranial Germ Cell Tumor.

“…INTRACRANIAL germ cell tumors mainly occur in adolescents and young adults, and their incidence is relatively high in Japan, being calculated to be 2.1 to 9.4% of all intracranial neoplasms occurring in adolescents and young adults [1,2]. According to cells of origin, germ cell tumors can be divided into germinoma and non-germinomatous germ cell tumor (teratoma, embryonal cell carcinoma, choriocarcinoma, endodermal sinus carcinoma and mixed germ cell tumors) [3].…”

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.…”

“…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.…”

“…Germinomas with STGC have a worse prognosis than pure germinomas 6) and tend to recur later than pure germinomas, 11) so the initial treatment should indicate both chemotherapy and radiation therapy and long-term follow up is essential.…”