Factors affecting functional prognosis in survivors of primary central nervous system germinal tumors

Ono, Nobuo; Kakegawa, Tadao; Zama, Akira; Nakamura, Masaru; Inoué, Hiroshi; Tamura, Masahito; Wakao, Tetsuo; Uki, Jiro; Takeda, Fumikazu; Kurihara, Hideyuki; Shimizu, Tsuneo; Handa, Ichiro

doi:10.1016/0090-3019(94)90201-1

Cited by 20 publications

(16 citation statements)

References 24 publications

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“…The posterior lobe function recovered in no patient and became even worse after the treatment, regardless of the tumor size. The DI persisted in all cases, which is largely consistent with other reports [3,6,9]. This shows that the posterior lobe function is impaired and irreversible at the early stage, because even a small germinoma can invade the neurohypophyseal system.…”

Section: Chemotherapy and Radiationsupporting

confidence: 80%

“…Hypogonadism and impaired gonadotropic hormone secretion was noted in almost all reported cases [3,7]. Thyroid and adrenal deficiency was present in 100 to 52% of reported cases [3,6,9]. Based on our study and review of literature, the pre-and post-treatment endocrinological studies demonstrated that pretreatment pituitary dysfunction persisted or worsened even after tumor remission [4,6] .…”

Section: Discussionmentioning

confidence: 92%

“…High cure rate of the tumors has been appreciated for years. At the same time, radiation related hypopituitarism, which was shown in our study, has been occasionally highlighted [1 , [6][7][8][9][10].…”

Section: Chemotherapy and Radiationmentioning

confidence: 99%

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Long-Term Outcome of Endocrine Function in Patients with Neurohypophyseal Germinomas.

et al. 2000

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Abstract.Since neurohypophyseal germinomas occur at the pituitary and hypothalamic axis in children and adolescents, the endocrinopathy is one of the common and critical QOL determinants. We carried out a retrospective study on the outcome of endocrine function in patients with neurohypophyseal germinoma, in order to improve or preserve pituitary function after treatment.Sixteen patients (7 men and 9 women), aged 6 to 26 years were admitted and followed up for 95.3 (14-197) months. DI was noted in 12 patients in pretreatment and 16 in posttreatment regardless of tumor size. We carried out the replacement of GH in all 8 patients, presenting the symptoms under 15 years of age. Gonadal or gonadotropic, thyroid and adrenal hormones were replaced in 9,12 and 15 patients, respectively.Patients with large tumor compressing chiasm or hypothalamus needed hormonal replacement such as gonadal or gonadotropic and thyroid hormones more frequently (<0.01) than those with small one. In addition, two patients with a small tumor at the pituitary stalk and the 3rd ventricle floor showed the improvement of secretion pattern in gonadotropins and ACTH after chemotherapy, although they later needed radiation therapy to control the tumor. Based on our study and review of literature, the endocrinological studies before and after treatment demonstrated that pituitary dysfunction present before treatment persisted or worsened even after tumor remission, except for patients with small and localized ones. The poor endocrine results is considered to be largely radiation-related.Chemotherapy alone seems to be insufficient to obtain complete response (CR). To avoid radiation related pituitary injury, combination of 24 Gy or less dosage of radiation and appropriate chemotherapy is essential. The earlier diagnosis by repeatedly using neuroimaging and serum and CSF tumor markers and earlier initiation of treatment, before irreversible pituitary-hypothalamic damage occurs, contributes to improvement of the outcome of pituitary functions in patients with neurohypophyseal germinomas.

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Section: Chemotherapy and Radiationsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 92%

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Long-Term Outcome of Endocrine Function in Patients with Neurohypophyseal Germinomas.

et al. 2000

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“…Surgical resection would be an appropriate means to address recurrent lesions in this region. An alternative approach to recurrence could be utilizing stereotactic radiosurgery as has been done successfully for meningiomas in this region [18, 19]. …”

Section: Discussionmentioning

confidence: 99%

Intracavernous Teratoma in a School-Aged Child

Becherer

Davis²,

Hodes³

et al. 1999

Pediatr Neurosurg

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An eight-year-old boy presented with left eye pain, photophobia, proptosis, third nerve paresis and decreased visual acuity. Magnetic resonance imaging revealed a nonenhancing mass filling the cavernous sinus. Using an extradural fronto-orbitozygomatic approach, the cavernous sinus was approached laterally, and a teratoma was removed from within the cavernous sinus. This is the first case of a truly intracavernous teratoma in a child and the fourth case of a teratoma reported in the cavernous sinus region overall. This report outlines the diagnosis and treatment of this unusual cavernous sinus tumor.

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“…The prognosis of extraembryonal tumors such as choriocarcinoma [1,2], embryonal carcinoma [3], or embryonal endodermal sinus tumors [2] is poor. In contrast to germinomas and teratomas, these tumors frequently produce an increase of tumor markers in serum, e.g., beta human chorionic gonadotropin (ß-HCG) in choriocarcinoma or alpha fetoprotein (AFP) in endodermal sinus tumors and both in embryonal carcinoma [3][4][5]. Adjuvant chemotherapy with, e.g., cisplatin and etoposide appears to be efficacious in intracranial nongerminomatous germ cell tumors [3].…”

Section: Introductionmentioning

confidence: 99%

Treatment and Long-Term Outcome of Pineal Nongerminomatous Germ Cell Tumors

Knappe

Bentele²,

Horstmann³

et al. 1998

Pediatr Neurosurg

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In 1994 we reported on a small series of 3 children with malignant, marker-positive pineal nongerminomatous germ cell tumors treated with a ‘sandwich’ protocol. Here, we report on the long-term survival of these children. Preoperative chemotherapy consisted of two courses of bleomycin, etoposide, and cisplatin. En bloc resection of the tumors via the supracerebellar, infratentorial route was performed immediately after decline of tumor marker levels. Postoperatively, two courses of vinblastine, ifosfamide, and cisplatin were applied, followed by craniospinal irradiation. The patients showed no major neurological deficits and no evidence (neuroradiologically or with regard to tumor marker levels) of recurrence of disease after 66, 71, and 78 months, respectively. We propose this regimen for children with tumors of the pineal region in whom the tumor markers are positive. It should be started without histological classification of the tumor to avoid possible spillage of malignant tumor cells to the cerebrospinal fluid.

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Factors affecting functional prognosis in survivors of primary central nervous system germinal tumors

Cited by 20 publications

References 24 publications

Long-Term Outcome of Endocrine Function in Patients with Neurohypophyseal Germinomas.

Long-Term Outcome of Endocrine Function in Patients with Neurohypophyseal Germinomas.

Intracavernous Teratoma in a School-Aged Child

Treatment and Long-Term Outcome of Pineal Nongerminomatous Germ Cell Tumors

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