Germ Cell Tumors Gc-01. the Treatment for Histologically Unconfirmed Intracranial Germ Cell Tumors: Experience of 38 Cases

Between May 2002 and August 2010, a total of 38 patients, who were clinically diagnosed as, but without surgical biopsy confirmation, intracranial germ cell tumors (GCTs) were treated at our Cancer Center. The patients were grouped into chemotherapy(n 1⁄4 21 ), radiotherapy(n 1⁄4 5), and stereotactic radiotherapy (n 1⁄4 12) based on the primary treatment. Median age of the patients at diagnosis was 16 years old with 33 males and 5 females. There were 68.4% (26/38) patients had elevatedb-HCG and/or AFP in serum, cerebrospinal fluid, or both. In which, 12 patients had received prior ventriculoperitoneal shunt. Twenty-one patients received primary chemotherapy, in which 17 patients followed by adjuvant radiotherapy. There were 9 complete responses (CR), 8 partial responses (PR), 2 stable diseases (SD) and 2 not evaluated (NA). The objective response rate (ORR) was 81%. Five patients received primary radiotherapy, 1 of which followed by adjuvant chemotherapy. There were 3 CR and 2 PR, the ORR was 100%. Twelve patients received primary stereotactic radiotherapy (SRS), in which, 4 patients followed by adjuvant chemotherapy, 8 patients received salvage chemotherapy when disease recurred. Six of 12 patients received whole brain or craniospinal radiotherapy after chemotherapy. There were 2 CR, 9 PR and 1 SD, and the ORR was 91.7%. Chemotherapy consisted of cisplatin, VP-16/VM-26 and bleomycin (PEB regimen). With a median follow-up of 29 months, 23 patients (60.5%) are alive without evidence of disease, while 6 patients died of tumor progression. The 2-year overall survival rate(OS) of total group was 79.5%. The 2-year OS of patients with primary chemotherapy, radiotherapy, and SRS was 89.1%, 66.7% and 90%, respectively (p 1⁄4 0.51). CONCLUSIONS: Chemotherapy and/or radiotherapy were highly effective in the patients with histologically unconfirmed intracranial GCTs. The optimal treatment for intracranial GCTs is worth further investigation.