Successful treatment of intracranial nongerminomatous malignant germ cell tumors by administering neoadjuvant chemotherapy and radiotherapy before excision of residual tumors

Kochi, Masato; Itoyama, Youichi; Shiraishi, Shoji; Kitamura, I; Marubayashi, Toru; Ushio, Yukitaka

doi:10.3171/jns.2003.99.1.0106

Cited by 80 publications

(46 citation statements)

References 25 publications

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“…Excellent results have been reported in patients in the poor prognosis group treated with neoadjuvant therapy, consisting of combined chemotherapy and radiation therapy, followed by complete resection of residual tumors, and all 7 patients survived for 39-177 months. 15 In our series, 2 patients, in whom gross-total resection was not achieved because of the tumor's anatomical location, experienced rapid growth and dissemination of the tumor, suggesting that more intensive neoadjuvant therapy is necessary to allow complete resection in the treatment of tumors in the poor prognosis group. Third, histological examination of the specimens from salvage surgery demonstrated that the treatment-resistant components consisted of fibrous tissue and yolk sac tumor or choriocarcinoma in the poor prognosis group, in contrast to teratoma or scar in the intermediate prognosis group.…”

Section: Treatment Of the Intermediate Prognosis And Poor Prognosis Nmentioning

confidence: 99%

“…Previous stud-ies have also demonstrated excellent results with salvage surgery and subsequent chemotherapy in the treatment of tumors in the intermediate prognosis group. 15,38 The poor prognosis group showed 3 characteristic patterns of recurrence and response to the treatment. First, tumor progression occurred very early, even during the initial treatment, which reflects the aggressiveness of these tumors.…”

Section: Treatment Of the Intermediate Prognosis And Poor Prognosis Nmentioning

confidence: 99%

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Optimal treatment strategy for intracranial germ cell tumors: a single institution analysis

Kanamori¹,

Kumabe²,

Saito³

et al. 2009

PED

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Object This study retrospectively analyzed the long-term outcomes of 108 consecutive patients to establish the classification and optimal treatment strategy for each subgroup of newly diagnosed germ cell tumors (GCTs). Methods A retrospective review of medical records from the authors' department between April 1989 and March 2007 identified 108 patients with newly diagnosed intracranial GCT. The diagnoses were germinoma in 83 patients, and nongerminomatous GCT (NGGCT) in 25 patients. Results In patients with germinoma, the 10-year overall and progression-free survival (PFS) rates at a median follow-up period of 99 months were 86 and 74%, respectively. Recurrences developed during a range of 6 to 153 months (median 26 months) after starting the initial therapy. Patients treated only with chemotherapy demonstrated a shorter PFS rate, and patients treated with chemotherapy followed by reduced-dose radiation therapy to the whole ventricle, whole brain, or craniospinal axis showed significantly better PFS than patients treated with only radiation or reduced-dose radiation therapy to the focal field. Nongerminomatous GCTs were divided into good, intermediate, and poor prognosis groups as proposed by the Japanese Pediatric Brain Tumor Study Group. In the good and intermediate prognosis groups, the 10-year overall and PFS rates were 100 and 93%, respectively. In the poor prognosis group, the 3-year overall and PFS rates were 56 and 29%, respectively. All patients with NGGCTs, in whom the lesions on MR imaging disappeared after combination therapies consisting of resection, radiation therapy, and chemotherapy, remained alive. Conclusions Chemotherapy followed by reduced-dose radiation therapy covering the whole ventricle improves the prognosis for patients with germinoma. Combined therapy of radiation therapy, chemotherapy, and radical resection as an initial or salvage treatment achieved excellent tumor control in the intermediate prognosis NGGCT group. The outcomes were still dismal in the poor prognosis NGGCT group, so initial therapy should target complete disappearance of all lesions on MR imaging.

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Section: Treatment Of the Intermediate Prognosis And Poor Prognosis Nmentioning

confidence: 99%

Section: Treatment Of the Intermediate Prognosis And Poor Prognosis Nmentioning

confidence: 99%

Optimal treatment strategy for intracranial germ cell tumors: a single institution analysis

Kanamori¹,

Kumabe²,

Saito³

et al. 2009

PED

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show abstract

“…6,11,18) However, a recent study found that patient survival in both groups has improved due to updated microsurgical techniques, combination multidrug chemotherapy and radiotherapy, and improved brain MR imaging. 12,15,16,29) Yolk sac tumors are hypervascular 1,8,11,18,19,25,28) and, in our case, the tumor bled heavily during dissection. Accordingly, we recommend that angiography be performed before surgery.…”

Section: Discussionmentioning

confidence: 94%

“…Other reports also recommend chemotherapy and/or radiotherapy before surgery to shrink the tumor and facilitate surgical intervention. 7,12,29) Taken together, these recommendations will prevent tumor dissemination during surgery.…”

Section: Discussionmentioning

confidence: 99%

Primary Yolk Sac Tumor Within the Lateral Ventricle -Case Report-

Tsugu

Oshiro

Ueno

et al. 2009

Neurol. Med. Chir.(Tokyo)

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A 13-year-old girl presented with an exceedingly rare case of primary yolk sac tumor located within the lateral ventricle, manifesting as headache, nausea, and diplopia. Magnetic resonance imaging revealed a 4-cm-diameter solid enhanced mass within the left inferior horn of the lateral ventricle. The tumor was removed subtotally via left middle temporal corticotomy. The histological and immunohistochemical diagnosis was pure yolk sac tumor. The serum alpha-fetoprotein (AFP) level was elevated at 1957.2 ng/ml and the serum beta-human chorionic gonadotropin level was 4 mIU/ml after surgery. The patient underwent radiotherapy (whole brain, 30 Gy; tumor bed, 21 Gy; whole spinal axis, 30 Gy) and chemotherapy (ifosfamide, cisplatin, etoposide). After three treatment cycles, the serum AFP level had decreased to 4.5 ng/ml. However, the tumor recurred with cerebrospinal fluid dissemination after nine cycles of chemotherapy. She died 18 months after surgery. The possibility of germ cell tumor should be considered in pediatric patients with brain tumors occurring outside the pineal or suprasellar region.

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“…20 It is recognized that, in older children, chemotherapy with platinum agents is effective for intracranial immature teratomas. 11,15,16 It is also known that neoadjuvant chemotherapy can induce differentiation of malignant germ cell tumors into mature teratomas. 8 The apparent tumor maturation presumably reflects the selective chemo-ablation of their actively proliferating components.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of hemorrhagic congenital intracranial immature teratoma with neoadjuvant chemotherapy and surgery

Fukuoka¹,

Yanagisawa²,

Suzuki³

et al. 2014

PED

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Congenital intracranial immature teratomas carry a dismal prognosis, and the usefulness of chemotherapy for these tumors has not been elucidated. The authors report on the successful management of a case of congenital intracranial immature teratoma by using neoadjuvant chemotherapy and surgery after the failure of an initial attempt at resection. The patient was an infant who had begun vomiting frequently at the age of 12 days and had been admitted to a hospital at the age of 18 days with continued vomiting, increased head circumference, and disturbance of consciousness. A CT scan of the brain revealed a large mass in his posterior fossa and hydrocephalus. Surgery was performed on an emergent basis, but only minor tumor resection could be performed due to massive intraoperative hemorrhage. The histopathological diagnosis was immature teratoma. Postoperatively, the infant was in critical condition due to severe postoperative complications, and when he was transferred to the authors' institution 43 days after birth, his respiratory condition was still unstable because of lower cranial nerve palsy. Chemotherapy with carboplatin and etoposide resulted in moderate shrinkage of the tumor. Further chemotherapy led to improvement in the patient's general condition and weight gain, which allowed for a second attempt at resection. During this second surgery, which was performed when the child was 8 months of age, after 8 courses of chemotherapy, the tumor was completely resected with little bleeding. Histological findings from the second operation were consistent with mature teratoma. This case indicates that upfront chemotherapy may be effective for the initial management of such cases. Although the objective response to the treatment was modest, chemotherapy reduced the hemorrhagic nature of the tumor, facilitated improvement of the patient's general condition, and allowed for successful resection.

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Successful treatment of intracranial nongerminomatous malignant germ cell tumors by administering neoadjuvant chemotherapy and radiotherapy before excision of residual tumors

Abstract: Neoadjuvant therapy, consisting of combined chemo- and radiotherapy, followed by complete excision of residual tumors is highly effective in patients with intracranial NGMGCTs.

Cited by 80 publications

References 25 publications

Optimal treatment strategy for intracranial germ cell tumors: a single institution analysis

Optimal treatment strategy for intracranial germ cell tumors: a single institution analysis

Primary Yolk Sac Tumor Within the Lateral Ventricle -Case Report-

Successful treatment of hemorrhagic congenital intracranial immature teratoma with neoadjuvant chemotherapy and surgery

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