Treatment and prognosis of patients with intracranial nongerminomatous malignant germ cell tumors

Ogawa, Kazuhiko; Toita, Takafumi; Nakamura, Katsumasa; Umemura, Takashi; Oda, Hiroshi; Itami, Jun; Shikama, Naoto; Saeki, Naokatsu; Yoshii, Yoshihiko; Murayama, Sadayuki

doi:10.1002/cncr.11495

Cited by 90 publications

(60 citation statements)

References 66 publications

(43 reference statements)

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“…1,4,19 Nongerminomatous GCTs are relatively resistant to radiation therapy and chemotherapy and are associated with a poor outcome. 9,21,26 Nongerminomatous GCTs consist of heterogeneous histological types, with a significant difference in the prognosis between pure malignant GCT and other types of NGGCTs. 21,26 Intracranial GCTs were divided into 3 groups based on treatment outcomes to establish treatment regimens for germinomas and NGGCTs.…”

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confidence: 99%

“…9,21,26 Nongerminomatous GCTs consist of heterogeneous histological types, with a significant difference in the prognosis between pure malignant GCT and other types of NGGCTs. 21,26 Intracranial GCTs were divided into 3 groups based on treatment outcomes to establish treatment regimens for germinomas and NGGCTs. A mature teratoma was classified into the good prognosis group.…”

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

Kanamori¹,

Kumabe²,

Saito³

et al. 2009

PED

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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.…”

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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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“…As to the analysis of 111 GCTs performed by Sawamura et al (8), the 5-year survival rate of 9 immature teratomas proved to be 67%. Moreover, Ogawa et al (17) reported 24 cases of intermediate prognosis of NGMGCTs. The 5-year survival rate was 68%.…”

Section: Discussionmentioning

confidence: 99%

“…The treatment for the poor prognosis group of NGMGCT patients was not ideally effective. Ogawa et al (17) analyzed the treatment of 41 NGMGCT patients and found the 5-year survival rate to be 8% in the poor prognosis group. In our study, only 1 out of 4 patients grouped in the poor prognosis group are currently alive.…”

Section: Discussionmentioning

confidence: 99%

Modified grading system for clinical outcome of intracranial non-germinomatous malignant germ cell tumors

Huang

Zhang²,

Mao³

et al. 2010

Oncology Letters

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Abstract. This study investigated the clinical outcome of intracranial non-germinomatous malignant germ cell tumors (NGMGCTs). All histologically proven cases of NGMGCTs treated in Shanghai Huashan Hospital, Fudan University were reviewed. A total of 39 cases were analyzed. There were 15 mixed germ cell tumors, 15 immature teratomas, 7 embryonal carcinomas and 2 yolk sac tumors. Patients were treated surgically first, followed by radiotherapy and/or chemotherapy. Some patients also received gamma knife surgery. The common 5-year survival rate was 36.8%. According to Matsutani's grading system, the 5-year actuarial survival rate for patients in the intermediate and poor prognosis groups were 45.8 and 14.3%, respectively. Individual analysis of each type of tumor showed that the median survival time of embryonal carcinoma was 27 months, which is very close to that of the intermediate group (28 months). We therefore classified embryonal carcinoma into the intermediate group where the 5-year actuarial survival rate for patients in the new intermediate prognosis group was 42.6%. Further analysis of immature teratoma cases found that the 5-year survival rate of patients with immature teratoma who received gamma knife surgery is 100%. This rate exhibited a significant difference (P=0.0049) compared to that of patients who did not undergo gamma knife surgery. In conclusion, we consider surgery as the first choice of treatment although for different histologis, the type of the tumor should be treated separately. IntroductionIntracranial non-germinomatous malignant germ cell tumors (NGMGCTs) include embryonal carcinoma, endodermal sinus tumor (also called yolk sac tumor), choriocarcinoma, teratoma (including immature teratoma and teratoma with malignant transformation) and mixed germ cell tumor. Historically, these tumors were rarely identified and were usually mistaken as a single category. However, different patterns of recurrence and survival were reported among different subtypes (1-3). Therefore, the relative roles of surgical resection, radiotherapy, chemotherapy and gamma knife surgery in the management of patients with such lesions have remained controversial (4). Between 1995 and 2007, 223 cases of germ cell tumors (GCTs) were treated in Shanghai Huashan Hospital, of which 39 cases (17.5%) were NGMGCTs. All the afore-mentioned cases were pathologically inspected and verified. The clinical features of these 39 cases of intracranial NGMGCTs were analyzed for the diagnosis and treatment of this disease. Materials and methods Patient population.A retrospective review of medical records from 1995 to 2007 identified 39 patients with intracranial NGMGCTs. In this group of medical cases, the male to female ratio was 33:6 and the age 2-40 years (median 14.2±3.5) ( Table I). In 19 cases, the tumor was located in the pineal region, while in another 11 it was located in the sellar region. Two tumors were located in the lateral ventricle, 3 in the third ventricle, 1 in the thalamus, 1 in the basal ganglia, 1 in the septum pel...

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Treatment and prognosis of patients with intracranial nongerminomatous malignant germ cell tumors

Cited by 90 publications

References 66 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

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

Modified grading system for clinical outcome of intracranial non-germinomatous malignant germ cell tumors

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