[Grading system for diagnosis and treatment of intracranial nongerminomatous malignant germ cell tumors].
OBJECTIVE
To discuss the clinical feature, treatment and prognosis of intracranial nongerminomatous malignant germ cell tumors (NGMGCT).


METHODS
The records of 39 patients receiving treatment at our hospital between 1995 and 2007 were reviewed retrospectively. According to the classification of Matsutani, they were grouped into intermediate prognosis and poor prognosis groups based on tumor histology. Clinical manifestations, diagnosis, treatment and outcome were analyzed in each group.


RESULTS
In these 39 cases, there were 15 mix germ cell tumors, 15 immature teratomas, 7 embryonal carcinomas and 2 yolk sac tumors. All patients were treated surgically. The tumor was totally removed in 29 cases, sub-totally in 5 and partially in 3. Biopsy was performed in the other 2 cases. Thirty-four patients (87.2%) were followed up. The overall 5-year survival rate was 36.8%. The 5-year actuarial survival rate for patients in the intermediate prognosis and poor prognosis groups were 42.6% and 0 respectively. Chemoradiotherapy had a significant correlation with the prognosis of intermediate prognosis group (P = 0.039). The 5-year survival rate of immature teratoma patients receiving post-operative gamma knife surgery was 100%. It had significant difference (P = 0.0049) as compared to the 5-year survival rate of patients receiving no gamma knife surgery.


CONCLUSIONS
NGMGCT can be divided into the intermediate and poor groups based on the prognosis (P = 0.0003). Embryonal carcinoma can be classified to the intermediate prognosis group because of its similar prognosis with immature teratoma and mixed tumors composed mainly of germinoma or teratoma. Surgery remains the first choice for NGMGCT since treatment should be based on tumor histology. For patients in the intermediate prognosis group, a combined regimen of surgical resection, radiotherapy, chemotherapy and gamma knife surgery is mostly effective.
Huang
Xiang
X
Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
Zhang
Rong
R
Zhou
Liang-Fu
LF
D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000145:classification* / Q000175:diagnosis / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000145:classification* / Q000175:diagnosis / Q000628:therapy; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult