Treatment of Primary Intracranial Germinomas

Abstract

The authors reviewed 24 cases of primary intracranial germinomas treated at Osaka City University Hospital between November, 1972 and June, 1984. The group comprised 17 males and seven females ranging in age from 8 to 45 years (mean, 19 years). Fourteen of the germinomas were in the pineal region, nine were in the suprasellar region, and one was in the fourth ventricle. Fourteen of the tumors were histologically verified prior to treatment. Radiation therapy was administered in all cases. Only two tumors were surgically removed. Seven patients have died; the overall 5-year survival rate was 60%. In five of the 15 cases (33%) in which only the brain was irradiated initially, spinal metastases developed during the post-irradiation period. None of the eight patients who underwent initial irradiation of the entire neuraxis developed spinal metastasis. The authors conclude that irradiation of the entire neuraxis is mandatory in patients with germinoma, in the interest of preventing dissemination to the spinal cord. In two instances metastasis to the peritoneal cavity occurred through the ventriculo-peritoneal shunt, and in both cases it was the cause of death. To prevent such fatal metastasis, the shunt system must be ligated or removed when the primary intracranial tumor shrinks or disappears following radiation therapy.