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• W2315694477 abstract "We studied 61 patients with primary intracranial germ cell tumors treated between 1954 and 1988 and reviewed previous reports. Our patient series included 48 males and 13 females with an age range of 5 to 41 years (mean, 15 years). Thirty-six tumors arose in the pineal region, 14 were suprasellar, and 11 in the basal ganglia and thalamus. There were 42 germinomas, 5 teratomas, and 14 malignant germ cell tumors (MGT) (8 embryonal carcinomas, 3 yolk sac carcinomas, and 3 choriocarcinomas). The diagnosis was histologically verified in 43 cases (29 operations, 12 autopsies, 2 cytological studies); the remaining 18 tumors were diagnosed on the basis of characteristic clinical and radiological features, tumor markers, and response to radiotherapy.We evaluated these patients' clinical symptoms, radiological images, and tumor markersexisting in both serum and cerebrospinal fluid (CSF) -revealed by immunohistochemistry. These markers included alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), carcinoembryonic antigen (CEA), and placental alkaline phosphatase (PALP). The levels cf tumor markers reflected tumor state and were well correlated with the histological diagnosis ; i.e., yolk sac carcinoma produced AFP ; choriocarcinoma, HCG ; embryonal carcinoma, AFP and HCG; teratoma, CEA ; and germinoma, PALP.The enzyme activity of PALP in CSF was measured by enzyme antigen immuno-assay (EAIA) in 14 patients in our laboratory. In 4 out of 6 germinoma patients, pre-treatment PALP in CSF exceeded 7 ng/ml and marked reductions occurred with radiation, while pre-and post-treatment PALP in patients with other germ cell tumors lower than 5 ng/ml. These results with EAIA suggested that measurement of PALP levels would be useful in the management of patients with germ cell tumors, particularly germinomas.The therapeutic regimens included surgery, irradiation, and chemotherapy. Germinomas were curable by radiation therapy. Teratomas were cured by microsurgery alone. Patients with radioresistant MGT and distant metastases had a poorer prognosis. Chemotherapy appeared to be a promising approach to treat MGT. Compared to radiation therapy alone, the theoretical advantages of chemotherapy include : 1) tumor specificity ; 2) control of occult distant metastases ; 3) a possible synergistic effect with radiation therapy ; and 4) reduction of the radiation dose and thereby lessening of the potential for late radiation-induced damage to the central nervous system.During the last 3 decades, dramatic improvement in the management and outcome of intracranial germ cell tumors has been accomplished by : 1) the introduction of high-resolution CT and magnetic resonance imaging ; 2) pre- and post-treatment assessment of tumor markers in serum and CSF ; 3) advances in microsurgical and stereotactic surgical techniques ; and 4) new chemotherapeutic agents and regimens. Questions and controversies remain, however. For example, should all pineal germinomas be biopsied or should radiation therapy be initiated without biopsy? How heavily can we rely on the histologic specificity of tumor markers? Is prophylactic spinal irradiation indicated in all cases of germinoma? What chemotherapy regimens are most effective against various types of MGT? Which is preferable as initial treatment of MGT, radiotherapy or chemotherapy? For further improvements in the treatment of primary intracranial germ cell tumors, more extensive investigation of their clinical and biological characteristics is necessary." @default.
• W2315694477 created "2016-06-24" @default.
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• W2315694477 date "1989-01-01" @default.
• W2315694477 modified "2023-10-14" @default.
• W2315694477 title "PRIMARY INTRACRANIAL GERM CELL TUMORS" @default.
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• W2315694477 doi "https://doi.org/10.2974/kmj1951.39.657" @default.
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