Successful treatment of extracranially metastasized pineal gland germinoma with high-dose methotrexate.
Germinoma of the pineal gland is a rare disease usually confined to the brain which responds well to radiotherapy. Spinal seeding occurs in approximately 4% of cases and distant metastases are extremely rare. We report on a 27-year-old female with an intracranially metastasized pineal gland germinoma, meningeal carcinomatosis and distant bone metastases. Treatment was initiated with intrathecal methotrexate (MTX) and continued with high-dose intravenous MTX. The therapy was very well tolerated apart from reversible hepatic toxicity requiring a dose reduction. The patient was in complete remission after three courses followed by two consolidation cycles; the patient has now been in continuous complete remission for more than 22 months. This is the first report to show that MTX is a potent drug in treating pineal gland germinoma. Long-term side effects of radiotherapy such as reduced mental function or hypopituitarism can probably be avoided. Single-agent high-dose MTX may provide high efficacy with limited adverse effects, especially at a more advanced tumor stage with spinal seeding and extracranial disease.
Fietz
T
T
Department of Medicine III (Hematology, Oncology and Transfusion Medicine), Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Germany. toffi001@zedat.fu-berlin.de
Thiel
E
E
Baldus
C
C
Blau
I W
IW
Stoltenburg
G
G
Knauf
W U
WU
D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000494:pharmacology*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D018572:Disease-Free Survival; D005260:Female; D018237:Germinoma / Q000188:drug therapy* / Q000532:radiotherapy / Q000556:secondary*; D006801:Humans; D007262:Infusions, Intravenous; D008577:Meningeal Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D008727:Methotrexate / Q000008:administration & dosage / Q000494:pharmacology*; D009367:Neoplasm Staging; D010871:Pinealoma / Q000188:drug therapy* / Q000473:pathology* / Q000532:radiotherapy; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate