Pineal tumors

Abstract

From 1972-1985, 30 patients with pineal area tumor have been treated with combinations of surgery and irradiation, no patient receiving chemotherapy as a primary recommendation. Patients ranged between 3 and 69 years of age, 18 were male and 12 female. In 18 patients a tissue diagnosis was made initially, 14 patients required shunts before definitive management and in 8 of the 14 tissue diagnosis was made at the same time. Eight patients had no surgical intervention at any time. Patients who have received irradiation have had whole brain irradiation, local field irradiation, or craniospinal irradiation. Two elderly patients died rapidly of their malignant processes before definitive treatment could be given. Only one patient with a non neoplastic lesion was seen. This was a bleed from an AVM with no underlying tumor. One patient with a pineocytoma was not irradiated. Overall, two-thirds of our patients are alive 5 to 15 years after treatment. There has been no surgical mortality and minimal morbidity from biopsy. Late effects of treatment include one patient with mild hearing loss and three patients with endocrinopathies amenable to medical treatment. We believe that tissue diagnosis allows optimal field design and dose recommendations to be made by the radiotherapist in addition to defining prognosis. In our experience, endodermal sinus tumor and pineoblastoma are highly malignant, and in view of their poor prognosis with conventional management consideration of more radical treatment with a possible role for chemotherapy is suggested.

Neuroendoscopic management of pineal region tumours

“…The landmark of this controversy is the need of histological diagnosis to plot a therapeutic strategy. Determination of tumour histology as an initial procedure is strongly supported by many European and American neurosurgeons [5,7,15,16,27,41,47], whereas almost all Asian neurosurgeons emphasize initial application of the radiation test [11,33,51]. The analysis of patient populations clearly reveals racial differences in tumour type incidence which explain this discrepancy [37].…”

“…Many authors agree that optimal clinical management of pineal area lesions depends on accurate histological diagnosis [5,7,15,16,27,41,47]. Some even consider the empirical treatment obsolete, specially concerning the Caucasian race [7].…”

“…The relative incidence of radiosensitive tumours in different racial groups justifies the empirical treatment emphasized by most Japanese neurosurgeons [11, 33,51]. Considering the Caucasian race, there is an increasing number of authors who consider that optimal clinical management of pineal turnouts depends on an accurate histological diagnosis [5,7,15,16,27,41,47].…”

Germ cell tumours of the central nervous system in children—controversies in radiotherapy

“…Most favour low dose CSI [13,16,22,23,[30][31][32]. However, as most GCT fail locally more recent literature favours more limited fields [8,33,34].…”

“…There is little data to support a therapeutic advantage to gross excision of a germinoma, although some authors, such as Schild et al recommend excision of residual NGCT (pineal) after chemotherapy [57]. Initial debulking surgery may also enhance local control [8,30]. Alternatively, residual immature teratoma after chemotherapy may be an indication for radiotherapy [5].…”