title: Long-term outcomes and late effects for childhood and young adulthood intracranial germinomas.
abstract: BACKGROUND
  Pediatric and young adult central nervous system (CNS) germinomas have favorable cure rates. However, long-term follow-up data are limited because of the rarity of this tumor. We report the long-term overall survival (OS) and causes of late mortality for these patients.
  
  
  METHODS
  Data between 1973 and 2005 from the Surveillance, Epidemiology, and End Results (SEER) database were analyzed. Kaplan Meier survival analysis was performed on 5-year survivors of childhood CNS germinomatous germ cell tumors (GGCTs) and nongerminomatous germ cell tumors (NGGCTs). Standardized mortality ratios (SMRs) were calculated using US population data to compare observed versus expected all-cause death and death from stroke. Cumulative incidence was calculated using a competing risk model.
  
  
  RESULTS
  Four hundred five GGCTs and 94 NGGCTs cases were eligible. OS at 20 and 30 years for GGCTs was 84.1% and 61.9%, respectively, and was 86.7% for NGGCTs at both time points. Five-year survivors of GGCTs and NGGCTs experienced a 10-fold increase in mortality risk compared with their peers (SMR, 10.41; 95% confidence interval [CI], 7.71-13.76 vs SMR, 10.39;95% CI, 4.83-19.73, respectively). Five-year survivors GGCTs also experienced a nearly 59-fold increase in risk of death from stroke (SMR, 58.93; 95% CI, 18.72-142.10). At 25 years, the cumulative incidence of death due to cancer and subsequent malignancy was 16% and 6.0%, respectively.
  
  
  CONCLUSIONS
  Although CNS germinomas have favorable cure rates, late recurrences, subsequent malignancies, and stroke significantly affect long-term survival. Close attention to long-term follow-up with assessment of stroke risk factors is recommended.
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (S.A., T.D., S.M.P.); Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee (E.T.S.).
authors.forename: Sahaja
authors.initials: S
authors.lastname: Acharya
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (S.A., T.D., S.M.P.); Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee (E.T.S.).
authors.forename: Todd
authors.initials: T
authors.lastname: DeWees
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (S.A., T.D., S.M.P.); Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee (E.T.S.).
authors.forename: Eric T
authors.initials: ET
authors.lastname: Shinohara
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (S.A., T.D., S.M.P.); Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee (E.T.S.).
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Perkins
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000453:epidemiology / Q000401:mortality*; D002423:Cause of Death; D002648:Child; D005260:Female; D018237:Germinoma / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D012042:Registries; D012307:Risk Factors
keywords: CNS; germinoma; late effects; stroke; subsequent malignancy