Abstract
Intracranial germinoma has usually been treated with radiation doses of 50 Gy or more, but it is unclear whether such doses are actually necessary to cure this radiosensitive tumour. At our institution, the standard radiation dose for intracranial germinoma was 60 Gy in the 1960s, but the dose has prospectively been reduced stepwise to 40-45 Gy. In this paper, the treatment outcome was assessed in 84 patients (47 with histologically confirmed disease and 37 diagnosed clinically in the post-computerised tomography era) enrolled in both prospective and retrospective series. The 5 and 10 years survival rates for all 84 patients were 88% and 83% respectively, and the corresponding relapse-free survival rates were 88% and 85%. The 10-year relapse-free survival rate was 88% for 31 patients receiving 19-47 Gy (median 42 Gy) to the primary tumour, 92% for 28 patients receiving 48-52 Gy (median 50 Gy), and 83% for 25 patients receiving 54-62 Gy (median 60 Gy), and there was no significant difference among the three groups. In-field local recurrence only developed in one patient who received 40 Gy over a protracted period and one patient who received 60 Gy. A tumour size < 3 cm and treatment in the post-computerised tomography era were associated with a better prognosis according to univariate analysis, while age, sex, tumour site, treatment volume, the radiation dose to both the primary and the spinal cord and the extent of surgical resection did not influence the prognosis. In contrast, none of these factors had a significant influence in multivariate analysis. In conclusion, intracranial germinomas < or = 4 cm in size can usually be cured with 40-45 Gy of radiation, thus avoiding the major adverse effects of brain irradiation.
Highlights
Smimmary Intracranial germinoma has usually been treated with radiation doses of 50 Gy or more, but it is unclear whether such doses are necessary to cure this radiosensitive tumour
A tumour size
This paper reports the results of our dose reduction study for intracranial germinoma, together with the long-term outcome in the patients previously given higher doses
Summary
Eighty-four patients with intracranial germinoma who received radiation therapy at our hospitals between January 1963 and December 1992 were eligible for this study. Forty-seven patients had histological confirmation of the diagnosis, while the remaining 37 patients were diagnosed on the basis of clinical criteria (Spiegel et al, 1976; Bloom, 1983; Shibamoto et al, 1994) including a typical age, tumour site, typical computerised tomography (CT) and/or magnetic resonance imaging (MRI) findings, and a rapid response to radiation therapy. Twentyone of these 37 patients had positive cerebrospinal fluid (CSF) cytology findings in which large and round germinoma cells were observed against a background of lymphocytes (Shibamoto et al, 1994). 12 patients had intraventricular CSF dissemination on CT/MRI and two had spinal metastasis on MRI/ myelography
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