Germ cell tumours of the central nervous system: treatment consideration based on 111 cases and their long-term clinical outcomes.
Germ cell tumours (GCTs) of the central nervous system (CNS) encompass various histological subtypes, and their optimal management has been the subject of debate. To indicate a better management strategy for each subtype, we analysed the records of 111 patients (median age 14 years), who underwent treatment since 1970. With a median follow-up duration of 86 months, the probability of surviving 5 years was: 96% for pure germinoma patients, 100% for mature teratoma, 67% for immature teratoma and 69% immature teratoma mixed with germinoma. The probability of cause-specific progression of germinomas producing human chorionic gonadotropin (HCG) was higher than that of non-producing germinomas (P < 0.01). GCTs that included a highly malignant component, such as embryonal carcinoma or yolk sac tumour, exhibited a poor prognosis with 38% chance of 5-year survival. Late adverse effects of therapy included stroke, secondary malignancy and cognitive, endocrinological, auditory and visual dysfunctions. Of 85 survivors with a median follow-up period of 99 months, 58 patients needed hormone replacement therapy, 26 patients showed poor performance status and, to date, only 1 patient has fathered children. Because the outcomes varied widely for each subtype, the traditional categories, that is, germinoma and non-germinomatous GCT as an extrapolation from the gonadal GCTs, are not suitable for appropriately selecting therapeutic regimen for CNS GCTs.
Sawamura
Y
Y
Department of Neurosurgery, Hokkaido University School of Medicine, Sapporo, Japan.
Ikeda
J
J
Shirato
H
H
Tada
M
M
Abe
H
H
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000209:etiology; D001284:Atrophy; D001921:Brain / Q000473:pathology; D016543:Central Nervous System Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D002539:Cerebral Arterial Diseases / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D015914:Estrogen Replacement Therapy; D005260:Female; D018237:Germinoma / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D006316:Hearing Loss, High-Frequency / Q000209:etiology; D006801:Humans; D007223:Infant; D017567:Karnofsky Performance Status; D008297:Male; D009336:Necrosis; D009364:Neoplasm Recurrence, Local; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology