title: Does the rapid response to cisplatin-based chemotherapy justify its use as primary treatment for intracranial germ-cell tumours?
abstract: We reviewed presentation, diagnostic problems and outcome of eight cases of primary intracranial germ-cell tumour (4 germinoma, 4 teratoma) treated with Cisplatin-based chemotherapy at our centre over the last ten years. Three patients received primary chemotherapy with Cisplatin-based regimens followed by radiotherapy for subsequent relapse, two were treated with a combination of chemotherapy and external radiotherapy, and three received chemotherapy for relapse after radiotherapy. The response to Cisplatin-based chemotherapy was rapid, with some patents exhibiting symptomatic improvement within 24 h. Four patients achieved complete remission within 21 days, and three of these have remained progression-free. Four patients in total have survived for 32 to 128+ months. Six of seven patients tested pre-treatment had central diabetes insipidus and five had partial anterior pituitary failure. The endocrine deficit progressed in two, with no recovery in any patient. It is arguable that chemotherapy should be the primary therapy in all such cases diagnosed on the basis of tumour markers and imaging, with surgery and/or radiotherapy as later options. As these tumours are rare, such questions can only be answered by collaboration studies.
authors.affiliation: Medical Unit, Royal London Hospital, Whitechapel, UK.
authors.forename: S
authors.initials: S
authors.lastname: Vijayaraghavan
authors.forename: C
authors.initials: C
authors.lastname: Brock
authors.forename: J P
authors.initials: JP
authors.lastname: Monson
authors.forename: G J
authors.initials: GJ
authors.lastname: Snodgrass
authors.forename: T T
authors.initials: TT
authors.lastname: King
authors.forename: C
authors.initials: C
authors.lastname: Gallagher
authors.forename: R T
authors.initials: RT
authors.lastname: Oliver
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002648:Child; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D018237:Germinoma / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010870:Pineal Gland / Q000000981:diagnostic imaging; D012658:Sella Turcica / Q000000981:diagnostic imaging; D012888:Skull Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed
chemical_list: D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin