Diagnostic radiation-induced regression of a metastatic primary intracranial germinoma: a case report (original) (raw)
Radiation therapy for intracranial germinoma: The case for limited volume treatment
International Journal of Radiation Oncology Biology Physics, 1990
Although radiation therapy has been universally accepted as the treatment of choice for primary intracranial germinomas, the optimal treatment technique continues to he a matter of controversy. Some authors advocate routine prophylactic craniospinal irradiation for all patients with localized intracranial germinomas whereas others have recommended partial brain fields. A retrospective analysis was performed on all 30 patients with tumors of the pineal and suprasellar regions irradiated at our institution between 1967 and 1987. Definitive histology was obtained in 23 patients. There were 13 germinomas and 10 non-germinomatous germ cell tumors. The 13 patients with biopsy proven germinomas constitute one of the largest modern series and will form the basis of this report. In all 13 patients, the tumor was confined to a single site within either the pineal region (9 patients) or the suprasellar regiou (4 patients). One patient with a pineal germinoma had CSF cytology positive for malignant cells and this patient was treated with craniospinal irradiation. Twelve patients were treated using partial brain fields encompassing either the tumor plus margin (10 patients) or the entire ventricular system followed by a boost to the primary tumalr (2 patients). With the exception of one patient, all patients received a total dose between 4900 and 5500 cGy to the primary (median 5040 cGy). The patient receiving less (3960 cGy) suffered from both local and spine relapse 26 months after diagnosis. The remaining 12 patients were free of disease at 81 months median follow-up time. We suggest that for patients with biopsy proven pineal or suprasellar germinomas, irradiation of partial brain is sufficient and craniospinal irradiation should be administered only to those patients with disease involving more thian one intracranial site, demonstrated meningeal seeding, or positive CSF cytology.
Journal of Nuclear Medicine & Radiation Therapy, 2017
Introduction: Germinomas are malignant intracranial germ cell tumors, usually found in pineal region. These tumors are exquisitely sensitive to radiation. Whole ventricle radiation (RT) with a boost field to the primary tumor is the standard treatment for localized germinomas. RapidArc radiotherapy is considered an excellent technological advance that shows great potential for producing highly conformal doses to treatment volumes. Case report: We present a case of intracranial germinoma who achieved a partial remission after four courses of chemotherapy induction. The patient received whole ventricular radiation therapy followed by a boost to the tumor and its margin to a total dose of 40 Gy using RapidArc radiotherapy over the course of 5 weeks. Any toxicity has been noted during the treatment. Early post treatment imaging showed a complete response. Conclusion: This case demonstrates a successful management of localized intracranial germinoma by RapidArc radiotherapy that allowed a highly conformal volumetric dose distribution with optimal sparing of surrounding areas of the brain.
Intracranial germinoma: treatment with radiosurgery alone--a case report
Journal of Neuro Oncology, 1998
The management of intracranial germinomas is controversial, with treatment options including conventional wide-field irradiation with or without chemotherapy or primary chemotherapy alone. The potential role of radiosurgery in the treatment of these lesions, although appealing, remains to be defined. We report a case whose initial management plan included radiosurgery to be followed by chemotherapy; however the patient subsequently refused chemotherapy. The presentation, diagnosis, treatment and results are discussed.
Cureus, 2016
Primary intracranial germ cell tumors are rare, representing less than 5% of all central nervous system tumors. Overall, the majority of germ cell tumors are germinomas and approximately one-third are non-germinomatous germ cell tumors (NGGCT), which include teratoma, embryonal carcinoma, yolk sac tumor (endodermal sinus tumor), choriocarcinoma, or mixed malignant germ cell tumor. Germ cell tumors may secrete detectable levels of proteins into the blood and/or cerebrospinal fluid, and these proteins can be used for diagnostic purposes or to monitor tumor recurrence. Germinomas have long been known to be highly curable with radiation therapy alone. However, many late effects of whole brain or craniospinal irradiation have been well documented. Strategies have been developed to reduce the dose and volume of radiation therapy, often in combination with chemotherapy. In contrast, patients with NGGCT have a poorer prognosis, with about 60% cured with multimodality chemoradiation. There are no standard approaches for relapsed germ cell tumors. Options may be limited by prior treatment. Radiation therapy has been utilized alone or in combination with chemotherapy or high-dose chemotherapy and transplant. We discuss two cases and review options for frameless radiosurgery or fractionated radiotherapy.
Journal of IMAB - Annual Proceeding (Scientific Papers), 2006
Germinomas are the most frequent type of germ cell tumors that constitute only 2-5% of all central nervous system malignancies. Most of them arise in the pineal and suprasellar regions but in about 5% to 10% the simultaneous location is found. Although their strategic location, they respond well to surgery, radiation and chemotherapy and the prognosis is very good. We report a case of 23years young male presented with gait disturbance, weakness in lower extremities, visual impairment and moderate fatigue. His medical history revealed that he was symptomatic by DI (polyuria, polydypsia and weight loss) and received treatment with adiuretin for a period of 3 years. Computed tomography (CT) scans demonstrated well circumscribed tumor lesions with a homogeneous contrast enhancement in the suprasellar and pineal regions. A germinoma was verified histologically. A good treatment response to surgery, radiation, chemotherapy and management of endocrine insufficiency was achieved. The postoperative neurological, CT and immunological follow-up corresponded with the clinical course of the disease and the results of therapeutic procedures.
Salvage craniospinal irradiation for recurrent intracranial germinoma: a single institution analysis
Journal of Radiation Research, 2023
This study investigated the effectiveness and safety of low-dose salvage craniospinal irradiation (CSI) for recurrent germinoma. We retrospectively reviewed long-term tumor control and late adverse effects in 15 recurrent germinoma patients treated at our hospital between 1983 and 2019. Following the first recurrence of germinoma, seven were treated with 24-30 Gy of salvage CSI, three underwent non-CSI, and five were treated with only chemotherapy. CSI achieved a significantly better recurrence-free survival rate after the first recurrence compared to other strategies (100% vs 33%, p < 0.001: log-rank test). To evaluate the safety of salvage CSI, we assessed the outcomes at the final follow-up of seven patients who received salvage CSI at first recurrence and three patients who received salvage CSI at second recurrence. The median follow-up period was 220 months after initial treatment. Five patients who received 40-50 Gy of radiation therapy or underwent multiple radiation therapy before salvage CSI were classified into Group A, whereas five patients treated with platinum-based chemotherapy and 24-32 Gy of radiation therapy to the primary site, whole ventricle, or whole brain were classified into Group B. In Group A, one had endocrine dysfunction and the other had visual dysfunction. None were socially independent. Meanwhile, in Group B, no endocrine or visual dysfunction was found, and three patients were socially independent. Salvage CSI achieved excellent tumor control in recurrent germinoma and was safe in patients initially treated with low-dose radiation therapy and chemotherapy.
Radiotherapy and Oncology, 1998
The treatment outcome of 24 patients with pathologically-proven non-germinomatous germ cell tumor was retrospectively investigated to determine the effectiveness of radiotherapy. The patients were divided into three groups as follows: group 1, five patients with mature teratoma with or without germinoma; group 2, six patients with immature teratoma with or without germinoma; group 3, 13 patients with other highly malignant tumors. The overall actuarial survival and relapse-free rates at 5 years were 82% and 59%, respectively, with a median follow-up period of 62 months. The actuarial relapse-free rate at 5 years was 100% for group 1, 63% for group 2 and 44% for group 3. There was no difference in the relapse-free rates between total resection and partial resection. Usage of chemotherapy was adversely related to survival probably due to selection bias. No local failure was observed with 10 Gy or more for group 1, 40 Gy or more for group 2 and 54 Gy or more for group 3. In groups 1 and 2, there was no spinal relapses without craniospinal irradiation. In group 3, three of eight patients who did not receive craniospinal irradiation and none of five patients who received craniospinal irradiation experienced spinal relapse. In conclusion, highly malignant GCTs show a high incidence of spinal metastasis and craniospinal irradiation may reduce the risk of spinal metastasis. Radiation dose and volume are to be determined according to the histopathological aggressiveness.
Cancer, 2011
BACKGROUND: Previous intracranial germinoma (IG) studies have investigated the effect of different radiotherapy (RT) volumes and the necessity for adjunctive chemotherapy, but there is currently no consensus on the best treatment for this tumor. METHODS: From January 1989 to December 2009, 80 IG patients (20 years old) were treated with various RT regimens. Of them, 14 patients had craniospinal irradiation (CSI) þ primary boost (PB); 8 patients had whole-brain irradiation (WBI) þ PB; 31 patients had whole ventricular irradiation (WVI) þ PB; and 27 patients had focal RT only. Twenty-nine patients (36.2%) also received systemic chemotherapy (CHT). Survival was estimated by the Kaplan-Meier method and variables affecting survival were analyzed by the Cox proportional hazard model. RESULTS: Eleven patients (13.8%) developed local recurrence or dissemination after treatment, and 10 of these patients were in the focal RT group. The 5-year relapse-free survival (RFS) for the CSI, WBI, WVI, and focal RT patients were 100%, 85.7%, 100%, and 84.6%, respectively (P ¼ .001). The 5-year overall survival (OS) for CSI, WBI, WVI, and focal RT patients was 100%, 83.3%, 100%, and 87.9%, respectively (P ¼ .125). Focal irradiation (P ¼ .02) and initial use of CHT (P ¼ .021) were negatively associated with RFS. CONCLUSIONS: Focal RT plus CHT were associated with inferior control of IG and a higher incidence of CHT-related toxicities. Adjustment of the radiation volume to the whole ventricular system without CHT is sufficient for treatment of nondisseminated IGs, even with lower primary RT doses (<36 Gy).
Germinoma with synchronous lesions in the pineal and suprasellar regions
Child's Nervous System, 2006
Background Germinomas represent the most frequent tumour type in the pineal region and the synchronous involvement of the suprasellar region, frequently termed bifocal disease, is increasingly recognised. The incidence, pathogenesis, histomorphological, radiological, clinical features, and management strategies are discussed. Case report A 6-year-old girl presented with clinical features of hypothalamic-pituitary axis dysfunction. MRI showed two distinct lesions in the pineal and suprasellar regions. Tumour markers for germ cell tumours from blood and cerebrospinal fluid were within the normal range. The suprasellar lesion was biopsied and the histology revealed a germinoma. She received a radical course of radiotherapy covering the entire craniospinal axis (24 Gy/15#) followed by focal boost to the sites of primary disease (16 Gy/10#). Three months after the completion of treatment, the patient achieved a complete clinical and radiological response, which was maintained during the 13-month follow-up period.