Long-term outcomes in patients with pineal nongerminomatous malignant germ cell tumors treated by radical resection during initial treatment combined with adjuvant therapy.
BACKGROUND
For pineal nongerminomatous malignant germ cell tumors (NGMGCTs), we mainly performed radical tumor resection during initial treatment combined with adjuvant therapy.


METHODS
We retrospectively analyzed 17 patients treated for pineal NGMGCTs between 1986 and 2007 at the University of Niigata.


RESULTS
Twelve patients underwent total or subtotal resection of their tumor via the occipital transtentorial approach. Five patients underwent partial resection, and four of them later underwent total resection by salvage surgery. After surgery, eight patients were treated with combined radiochemotherapy including whole-brain irradiation, two received radiation monotherapy, one had chemotherapy with local irradiation, and six were treated with chemotherapy alone. The median follow-up period for surviving patients was 179 months. The 10-year overall survival and progression-free survival rates for the radiochemotherapy group were both 75.0 % (two patients had a recurrence and died); the rates for other adjuvant therapies were 77.8 % (two died) and 22.2 % (seven had a recurrence), respectively. Radiochemotherapy was significantly associated with an increased rate of progression-free survival compared with the other adjuvant therapies (p = 0.0396).


CONCLUSIONS
For pineal NGMGCTs, initial treatment strategies including gross total resection of the tumor before or after whole-brain irradiation and chemotherapy provided good therapeutic outcomes. Obtaining complete remission of the primary tumor, irrespective of the timing of surgical resection (i.e., before or after adjuvant therapies), or complete response by neoadjuvant radiochemotherapy during an initial treatment appears to be essential for improving therapeutic outcomes of intracranial NGMGCTs.
Department of Neurosurgery, Brain Research Institute, University of Niigata, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8585, Japan. jinguji@bri.niigata-u.ac.jp.
Shinya
S
Jinguji
Department of Neurosurgery, Brain Research Institute, University of Niigata, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8585, Japan.
Junichi
J
Yoshimura
Department of Neurosurgery, Brain Research Institute, University of Niigata, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8585, Japan.
Kenichi
K
Nishiyama
Department of Neurosurgery, Brain Research Institute, University of Niigata, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8585, Japan.
Yuichiro
Y
Yoneoka
Department of Neurosurgery, Brain Research Institute, University of Niigata, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8585, Japan.
Masakazu
M
Sano
Department of Neurosurgery, Brain Research Institute, University of Niigata, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8585, Japan.
Masafumi
M
Fukuda
Department of Neurosurgery, Brain Research Institute, University of Niigata, 1-757, Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8585, Japan.
Yukihiko
Y
Fujii
D000293:Adolescent; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000601:surgery* / Q000628:therapy; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010870:Pineal Gland / Q000601:surgery; D010871:Pinealoma / Q000601:surgery* / Q000628:therapy; D055815:Young Adult
Brain tumor; Intracranial germ cell tumor; Nongerminomatous germ cell tumor; Occipital transtentorial approach; Pineal tumor