Long-term results of treatment of 30 patients with primary intracranial germinoma / 中华放射肿瘤学杂志

ABSTRACT

Objective To report long term results of 30 patients with primary intracranial germinoma and evaluate the treatment policy. Methods After the tumor of these 30 patients was completely or partially removed they were routinely given radiation therapy with the conventional extenal irradiation. Of these 30 patients, 28 received prophylactic whole brain irradiation followed by the cone down technique to the local site to an effective dose except 2 patients who were treated locally without prophylactic irradiation.Nineteen patients received prophylactic spinal cord irradiation.Results The overall 5 ,10 , 15 ,19 year survival rates were 93.1%, 87.6% ,87.6% and 68.2%,respectively.The two patients who did not receive prophylactic whole brain irradiation (1 patient) or too low a dose of that (1 patient) developed metastasis in the brain and spinal cord were given a second course of radiotherapy. One survived for 17 years and the other is living now over 10 years. The overall response rate (CR + PR) was 95%.Conclusions While surgery is indicated to reduce the tumor volume, shunt the hydrocrania and obtain a pathologic diagnosis, radiotherapy is invaluable to cure germinoma. Prophylactic whole brain irradiation of 26～30 Gy is necessary and the curative local dose should be 50～55 Gy. Prophylactic spinal cord irradiation is not indicated routinely except some appropriate patients. For patients younger than 14 years, shielding of the pituitary is necessary while the prophylactic whole brain is being irradiated. The tumor dose at the sella turcica region should be limited to 56 Gy, and the spinal cord need not be irradiated prophylactically.