title: Utility of MRI versus tumor markers for post-treatment surveillance of marker-positive CNS germ cell tumors.
abstract: Patients with marker-positive central nervous system (CNS) germ cell tumors are typically monitored for tumor recurrence with both tumor markers (AFP and b-hCG) and MRI. We hypothesize that the recurrence of these tumors will always be accompanied by an elevation in tumor markers, and that surveillance MRI may not be necessary. We retrospectively identified 28 patients with CNS germ cell tumors treated at our institution that presented with an elevated serum or cerebrospinal fluid (CSF) tumor marker at the time of diagnosis. We then identified those who had a tumor recurrence after having been in remission and whether each recurrence was detected via MRI changes, elevated tumor markers, or both. Four patients suffered a tumor recurrence. Only one patient had simultaneously elevated tumor markers and MRI evidence of recurrence. Two patients had evidence of recurrence on MRI without corresponding elevations in serum or CSF tumor markers. One patient had abnormal tumor markers with no evidence of recurrence on MRI until 6 months later. We conclude that in patients with marker-positive CNS germ cell tumors who achieve complete remission, continued surveillance imaging in addition to measurement of tumor markers is indicated to detect recurrences.
authors.affiliation: NYU School of Medicine, New York, NY, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Cheung
authors.affiliation: Division of Pediatric Hematology/Oncology, Department of Pediatrics, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Devorah
authors.initials: D
authors.lastname: Segal
authors.affiliation: Division of Pediatric Hematology/Oncology, Department of Pediatrics, NYU Langone Medical Center and Perlmutter Cancer Center, New York, NY, USA.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Gardner
authors.affiliation: Division of Neuropathology, Department of Pathology and Neurosurgery, NYU Langone Medical Center and Perlmutter Cancer Center, New York, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Zagzag
authors.affiliation: Division of Pediatric Neurosurgery, Department of Neurosurgery, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Wisoff
authors.affiliation: Division of Pediatric Hematology/Oncology, Department of Pediatrics and Neurology, NYU Langone Medical Center and Perlmutter Cancer Center, New York, NY, USA.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Allen
authors.affiliation: Division of Pediatric Hematology/Oncology, Department of Pediatrics and Otolaryngology, NYU Langone Medical Center and Perlmutter Cancer Center, New York, NY, USA. matthias.karajannis@nyumc.org.|Stephen D. Hassenfeld Children's Center for Cancer & Blood Disorders, NYU Langone Medical Center, 160 East 32nd Street, 2nd Floor, New York, NY, 10016, USA. matthias.karajannis@nyumc.org.
authors.forename: Matthias A
authors.initials: MA
authors.lastname: Karajannis
mesh_terms: D000293:Adolescent; D000328:Adult; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002648:Child; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000000981:diagnostic imaging* / Q000378:metabolism*; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D014408:Biomarkers, Tumor; D018997:Chorionic Gonadotropin, beta Subunit, Human; D000509:alpha-Fetoproteins
keywords: CNS tumors; Germ cell tumors; Surveillance MRI; Tumor markers