Successful Chemotherapy of Pinealoma

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.

Section: Discussionmentioning

confidence: 99%

Pineal tumors

Linggood

CHAPMAN

1992

“…Rapaport [15] has pointed out that there is not a blood-brain barrier for the pineal gland, and therefore chemotherapy could be expected to be more effective. DeTribolet [16] reported regression of a pineal-region tumor with daunorubicin, vincristine, and bleomycin.…”

Section: Discussionmentioning

confidence: 99%

Pinealomas and germinomas in children

Farwell

Flannery

1989

A series of 34 pinealomas and intracranial germinomas in childhood (age less than 20), from two tumor registries, is analyzed. Male to female ratio was 2:1. Median age was 12 years. Visual complaints and endocrine disturbances were the most common presenting symptoms. Papilledema, visual field deficits, and oculomotor abnormalities were the principal findings at diagnosis. Cumulative probability of survival (CPS) of the entire series at one year was 0.65, at two years 0.54, and at five years 0.54. Best survival was with treatment by operation and radiation: CPS at one year was 0.82, at two years 0.82, and at five years still 0.82. Survival was similar with pineal region tumors and with suprasellar tumors. Most long-term survivors, particularly with suprasellar germinomas, had permanent hormonal deficits requiring replacement therapy.

“…Information on the efficacy of either bleomycin and vinblastine alone in central nervous system malignancies is sparse, although successful treatment of intracranial germ cell neoplasms with the three-drug regimen has been reported. The three-drug combination has also been effective against extracranial germ-cell neoplasms (13,14,15,16). Although there is conflicting evidence whether or not bleomycin and vinblastine cross the blood-brain barrier (15,17), it is not known wether presence of a given drug in the cerebrospinal fluid is critical for successful treatment of brain tumors (17).…”

Section: Discussionmentioning

confidence: 99%

Response of a recurrent choroid plexus tumor to combination chemotherapy

Maria

Graham²,

Strauss³

et al. 1985

Choroid Plexus tumors are rare. Surgery and biopsy is diagnostic, and radiotherapy has been used as the treatment of choice for choroid plexus carcinoma (CPC) and recurrent choroid plexus papilloma (CPP). We report the first case of CPP responding to combination chemotherapy consisting of cisplatin, bleomycin and vinblastine (CBV). This chemotherapy regimen should be considered for future trials in patients with choroid plexus tumors and recurrence after surgery and/or radiotherapy.