RARE-27. UNUSUAL CASE OF TEENAGER WITH PRIMARY SPINAL GERMINOMA WITH INTRACRANIAL RELAPSE POST-THERAPY

Abstract

Abstract We present a case of a 14-year-old male who presented with back pain and difficulty walking and was found to have an intradural intramedullary germinoma in the thoracolumbar spine. After debulking, he was treated with four cycles of carboplatin and etoposide and then received local spinal radiotherapy (RT) to the initial area of disease with margin to 30 Gy in 17 fractions. Six months following completion of therapy, he was found to have an intracranial relapse. CLINICAL IMPORTANCE: Our patient is the second ever Hispanic and twelfth pediatric patient reported with primary spinal germinoma. We reviewed 54 total cases published in literature over last 35 years. Twenty-one patients (39%) were treated with surgery followed by local spinal RT (n=12) or CSI (n=9). Twenty-eight patients (52%) were treated with chemotherapy in addition to surgery and radiation. The remaining 5 patients (9%) either had surgery alone or details of their treatment plan were not reported. Six of the 54 patients experienced disease recurrence. None of the patients treated with CSI experienced disease recurrence after CSI. Ninety-six percent of patients were alive at last follow up. CLINICAL OUTCOME: Our patient had his relapsed disease resected and CSI to 23.4 GY in 13 fractions and focal boost to 21.6 Gy in 12 fractions was delivered to all sites of relapsed disease. He is undergoing surveillance of his tumor and there is no disease recurrence 3 months post-CSI. CONCLUSION: Primary spinal germinomas appear chemo responsive and radiosensitive; however, the optimal management to maximize disease control and minimize side effects is not clear. When using local spinal RT, close surveillance with brain and spine imaging seems indicated as relapses anywhere in the central nervous system are possible. Further study is needed to determine the optimum treatment approach to this tumor.