Long-term follow-up results of radiation therapy for germinoma

Higher radiation doses for germ cell tumors (GCT) than were employed previously have reduced the rate of local recurrence. Nevertheless, we believe that we have to change the concepts of the management for primary intracranial GCT in view of the considerable advances in serological biomarkers and effective chemotherapy for testicular GCT. We reviewed 40 patients with primary intracranial GCT treated at our institution between 1975 and 1989. There were 29 males and 11 females with a mean age of 16.3 years, with 29 germinomas and 11 non-germinomatous GCT. In this series, the range of the radiation dose was 4,000 to 7,950 rad given by local (3,000 to 6,950 rad) and whole brain (2,000 to 6,000 rad) irradiation. Principally prophylactic spinal radiation (1,500 to 2,000 rad) was added. Of the 40 patients, 32 had detailed follow-up examinations and were eligible for the final analysis of postradiotherapeutic long-term results (24 are still alive). The data reveal that two factors are related to survival: the tumor does not contain malignant components of non-germinomatous GCT, and absence of metastasis, as several reports have noted. Radiotherapy for germinoma was considered to be satisfactory if there was no local recurrence. However, 81% of survivors had complications probably due to delayed effects of radiotherapy. Some of them had memory disturbances (11 of 24 patients, 46%) and some psychiatric problems (6 of 24, 25%). Almost all patients with complications had received more than 5,000 rad, particularly whole brain irradiation over 2,000 rad. No definite correlation was found between metastasis and prophylactic spinal irradiation. We conclude that in the appropriate irradiation treatment for germinoma, the total dose should be 4,500-5,000 rad, with no more than 2,000 rad of whole brain irradiation. In addition, we believe that it is not necessary to perform prophylactic spinal irradiation for growing children unless there is a high risk of metastasis. (author)