GCT-17. Recurrence of CNS germ cell tumors (GCTs) along biopsy and ventriculostomy tracts

Abstract

Abstract BACKGROUND: Central nervous system (CNS) germinoma relapses are rare. However, the latest Children’s Oncology Group (COG), ACNS1123 stratum 2, described three relapses along the biopsy tract out of eight total relapses; two along the biopsy and endoscopic third ventriculostomy (ETV) tract and one along the biopsy tract and external ventricular drain. Given these findings, we sought to describe other cases of GCT recurrence along surgical tracts. METHODS: We performed a literature review from 1980-2021 to identify cases of GCT recurrence along biopsy and ventriculostomy tracts. RESULTS: Three patients with pineal lesions were identified (13, 14, and 34-years old). All underwent ETV, cerebrospinal fluid (CSF) sampling, and tumor biopsy. Two patients had uncomplicated postoperative courses. One developed persistent hydrocephalus and underwent repeat ventriculostomy. Two were diagnosed with pure germinoma and treated with focal radiotherapy of 45 Gy alone or chemotherapy and radiation (50.4 Gy to the tumor volume and 36 Gy to adjacent high-risk area). The third was treated with methotrexate and corticosteroids. All three had recurrence on surveillance MRI (1-3 years after diagnosis). One had recurrence at the ventriculostomy bur hole site, and two had recurrence along the ventriculostomy tract. On biopsy, all three lesions were germinomas. One received pre-radiation chemotherapy and palliative radiation (36 Gy to surgical bed and 30.6 Gy to surrounding high-risk area). Another received chemotherapy and craniospinal radiation of 15 Gy. The third had a complicated post-biopsy course. He ultimately underwent chemotherapy and radiation (24 Gy). All were still alive at time of report. Two were disease free at 12 and 18 months, while one was still receiving chemotherapy. CONCLUSION: Recurrence along the biopsy or ventriculostomy tract is rarely reported in the literature. Future evaluation to determine the incidence could inform if biopsy and ventriculostomy tracts should be included in the radiation therapy field.