Recurrent intracranial germinoma outside the initial radiation field: A single-institution study

Figures & data

Table I.  QOL analysis in patients with germinomas who received the whole brain radiotherapy between 1976 and 1991.

Social activity	Total 22
normal activity	14 (61%)
unable to work	7 (31%)
dead	1
Hormonal replacement	Total 16*
DDAVP	14
cortisol	6
thyroideum	7
GH	4
sexogens	2

DDAVP: 1-desamino[8-D-arginine]vasopressin GH: growth hormone.

*In 22 patients with germinoma there were 16 patients with germinomas at suprasellar neurohypothalamic region.

Table II.  Characteristics of patients with germinoma or germinoma STGC since 1992 (total 30 cases).

Male/Female	21/9
Age at diagnosis
range (median)	4–53 (17)
Tumor location
pinel	10
suprasellar	(SS) 11
pineal & SS	5
basal ganglia	4
Diagnosis
geminoma	22
germinoma with STGC	8
Tumor marker positive (range)
AFP	0^#
HCG	n.d.
β-HCG	8 (0.17–27)
Radiotherapy
local 24 Gy	7
whole brain 30 Gy + local 20Gy	2
extended local 30Gy + local 20Gy	16
extended local 24Gy	5
Chemotherapy
CBDCA (450 mg/m^2) or CDDP (100 mg/m^2) + VP-16(450 mg/m^2)	26
IFOS(4500 mg/m^2) + CDDP(100 mg/m^2) + VP-16(300 mg/m^2)	4
Operation
biopsy	22
patial removal	3
total removal	1
none	4

^#AFP positivity was assigned when the level was >20. n.d.: not determined CBDCA: carboplatin VP-16: etoposide IFOS: ifosphamide CDDP: cisplatin

Table III.  Germinoma Recurrence rate in the treatment of each Radiotherapy.

local 24 Gy	3/7
whole brain 30 Gy + local 20 Gy	0/2
extended local 30 Gy + local 20 Gy	1*/16
extended local 24 Gy	0/5

*Extended local radiation was not adequately designed and the recurrent tumor originated from the outside of the radiation field.

Figure 1.  Case 1, a 12-year-old boy. a: Pre-treatment MRI scan revealing a pineal mass. b: Post-treatment MRI scan revealing disappearance of the pineal mass. c: On this x-radiograph, the field of irradiation (gray area) and ventricles (white area) on MRI scans are traced. The relapse site is identified by a hatched circle. d: This post-treatment MRI scan shows an enhanced lesion in the posterior horn of the left lateral ventricle (arrow).

Figure 2.  Case 2, a 15-year-old boy. a: Pre-treatment MRI scan revealing a pineal mass. b: Post-treatment MRI scan reveals complete disappearance of the pineal mass. c: On this x-radiograph, the field of irradiation (gray area) and the ventricles (white area) on MRI scans are traced. The relapse site is identified by a hatched circle. d: This post-treatment MRI scan reveals an enhanced lesion in the anterior horn of the right lateral ventricle (arrow).

Figure 3.  Case 3, a 16-year-old boy. a: Pre-treatment MRI scan revealing an enhanced lesion in the right basal ganglia. b: Post-treatment MRI scan shows complete disappearance of the lesion. c: On this x-radiograph, the field of irradiation (gray area) and the ventricles (white area) on MRI scans are traced. The relapse site is identified by a hatched circle. d: This post-treatment MRI scan (axial view) reveals an enhanced lesion in the inferior horn of the right lateral ventricle (arrow). e: MRI scan obtained at the time of tumor recurrence (coronal view).

Figure 4.  Case 4, an 11-year-old boy. a: Pre-treatment MRI scan revealing a hypothalamic enhanced lesion. b: Post-treatment MRI scan shows complete disappearance of the hypothalamic mass. c: On this x-radiograph, the field of irradiation (gray area) and the ventricles (white area) on MRI scans are traced. The relapse site is identified by a hatched circle. d: MRI scan obtained at the time of tumor recurrence shows an enhanced lesion in the body of the right lateral ventricle (arrow).

Table IV.  Characteristics of the patients with recurrence of the germinoma at the outside of the initial radiation field.

Case	Age/gender	Site	Histology	OP	CHT	RT	Time to ralapse	Site of relapse	TR for R	Outcome
1	12/M	P/SS	germinoma	none	PE	ext. local 30 Gy + local 20 Gy	56 mo. posterior horn	Left LV γ-knife	ICE + RT	die
2	15/M	P	germinoma	biopsy	PE	local 24 Gy	21 mo. anterior horn	Right LV	ICE + RT	CR
3	16/M	BG	germinoma	biospy	PE	local 24 Gy	25 mo. inferior horn	Right LV	ICE + RT	CR
4	11/F	SS	germinoma	biopsy ICE	PE	local 24 G	18 mo. body + RT	Right LV	PE/Bleo	CR

CHT: chemotherapy RT: radiotherapy P: pineal SS: suprasellar PE: carboplatin + etoposide LV: lateral ventricle CR: complete response ICE: ifosphamide + cisplatin + etoposide Bleo: bleomycin.