Abstract
Intracranial germinoma (IG) rarely occurs in adults. Its optimal treatment strategy is unclear. We evaluated the outcomes of radiotherapy in adults with intracranial germinoma. Data of 29 adult patients (age, 18–52 years; median age, 24.3 years) with IG treated with radiotherapy at Taipei Veterans General Hospital were retrospectively reviewed. They were followed up for a median time of 5.9 years (range, 1.0–12.8 years). We used the Kaplan–Meier method to estimate the progression-free survival (PFS) and overall survival (OS), and univariate and multivariate Cox proportional hazards regression models to identify the factors affecting PFS. PFS and OS were compared between adult and pediatric patients with IG. The 1-, 3-, and 5-year PFS rates were 96.6%, 85.8%, and 77.8%, respectively, in the adult patients, and the OS rate were all 100%. Seven patients (24.1%) experienced recurrence, and in six of them, salvage therapy successfully controlled the disease. Two patients (6.9%) died after 5 years of follow-up due to disease progression and central pontine myelinolysis. In the univariate and multivariate Cox analysis, bifocal lesions had a significantly lower PFS than those with single lesions (p = 0.008). Kaplan–Meier survival analysis showed that adult patients had a poorer PFS (p = 0.06) and OS (p = 0.025) than pediatric patients. Our study showed bifocal lesions were associated with lower PFS than a single lesion among adult IG patients, and adult IG patients tended to have poorer PFS and OS compared to pediatric IG patients. For adult patients with bifocal IG, we recommend treatment with craniospinal irradiation, whole ventricle irradiation (WVI) with chemotherapy, or frequent spine images follow-up for patients who received only WVI.
Highlights
Intracranial germ cell tumor (IGCT) is a rare type of cancer that affects approximately 0.6–1.0 per million people per year in the United States and Europe [1], and it represents 0.5–3% of primary neoplasms in North America and Europe [2]
Univariate and multivariate Cox analysis revealed that there was a significant difference in progression-free survival (PFS) between patients with bifocal and single lesions on diagnosis
Adult patients with Intracranial germinoma (IG) tended to have a lower PFS and a significantly lower overall survival (OS) as compared to the pediatric patients with IG treated in the same period
Summary
Intracranial germ cell tumor (IGCT) is a rare type of cancer that affects approximately 0.6–1.0 per million people per year in the United States and Europe [1], and it represents 0.5–3% of primary neoplasms in North America and Europe [2]. Recent literature has reported similar incidences in Japan and the United States [5]. It affects 0.5 per million people per year in the United States [5]. IGs generally occur during childhood and adolescence, and 90% of patients are diagnosed before the age of 20 years [6]. IGs in older adults are rare, with only a few case reports and one case series documented in literature [7–9]. Investigating the optimal treatment for adult patients with IGs is important
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