Intracranial germ cell tumors: a single-institution experience

Intracranial germ cell tumors [GCTs] are not a common disease. We reviewed the experience of a single institution to determine the variables that affect treatment outcome. A retrospective review of patients with the diagnosis of intracranial germ cell tumors treated in a single institution [KFSHRC] during the period from March 1985 to December 2007. Fifty-seven patients with the diagnosis of intracranial GCT were recorded in the KFSHRC Tumor Registry during the period from 1985 to 2007. Seven patients with a pineal region tumor treated as germinomas in the earlier years without a tissue diagnosis were excluded. This retrospective study was restricted to the remaining 50 patients with a tissue or marker diagnosis: 31 germinomas and 19 non-germinomatous germ cell tumors [NGGCTs]. The 10-year overall survival [OS], event-free survival [EFS] and relapse-free survival [RFS] were 87%, 88% and 96% for patients with germinoma, with a median follow-up of 4.5 [range 2-17] years, compared with 26%, 29% and 46% for patients with NGGCT with a median follow-up of 3 [range 1.5-13] years. For NGGCT, variables favorably influencing OS were younger age [< 16 y vs >/= 16 y, P=.01], higher radiation dose [>50 Gy vs 1990 vs <1990 P=.002]. Tissue diagnosis of GCTs is mandatory prior to treatment except for patients with elevated markers. In germinoma, localized radiotherapy [RT] for M0 patients may be adequate. Long-term follow-up is needed to define the benefit of adding chemotherapy. For NGGCT, the use of combined modality treatment and RT dose >50 Gy are important factors that influence the outcome. Second-look surgery and resection of residual/refractory tumors is always recommended

Outcome of surgery for intramedullary spinal ependymoma

Ependymoma is the most frequently encountered intramedullary tumor. Total surgical resection is the therapeutic modality of choice whenever possible, but carries a significant risk of morbidity. This study was designed to define prognostic factors that affect clinical outcome after surgical resection of spinal intramedullary ependymoma. The medical records, radiological and pathological studies of all patients with intramedullary spinal ependymomas treated surgically in one institution were reviewed retrospectively. Spinal myxopapillary ependymomas were excluded. In a multivariable regression analyis, possible prognostic factors were correlated with the 6-month postoperative neurological status using McCormick's grading scale. Surgery was performed on 17 patients [14 males, 3 females, mean age of 42 +/- 15 years] with spinal ependymoma. The cervical spine was the most common tumor location [71%]. Total surgical resection of the tumor was achieved in 11 cases [65%]. Intraoperative neurophysiological monitoring was used in 8 cases [47%]. Postoperatively, 11 patients [65%] either improved or had no change from their preoperative neurological status. None of the 11 totally resected tumors has shown evidence of recurrence in a follow-up period range from 8-120 months [median, 33 months]. Of several possible prognostic factors, the only statistically significant correlation identified with the 6-month postoperative neurological status was the preoperative McCormick grading score. Preoperative neurological status was the only statistically significant factor in determining the postoperative neurological outcome of patients with spinal intramedullary ependymomas. Early diagnosis and referral for surgery to specialized centers are recommended as controllable factors in improving outcome

Pineal tumors: Treatment and results in 24 patients at one institution

From 1979-1991, 24 patients with pineal region tumors were treated at King Faisal Specialist Hospital. Nineteen patients had histologically Verified tumors, pineal parenchymal 14, germ cell 3 and gliomas in 2 patients. Two of the 5 patients without biopsy had elevated levels of alpha fetoproteins. Surgery was performed in 20 patients. Tumor excision was complete in one patient and partial in 11 patients. Biopsy alone was done in 7 cases. Seventeen patients required a Shunting procedure, and in one patient, it was the only surgical procedure. Twenty patients received primary radiation treatment, localized radiation to the primary site 5, whole brain irradiation followed by a boost to the primary site 6 and craniospinal radiotherapy in 9 patients. The radiation doses varied between 30-55 Gy for the primary site and from 30.6-36 for the whole neuraxis. Three patients with germ cell tumors received chemotherapy. The overall 5-year actuarial survival was 42%