Article Text

MALIGNANT INTRACRANIAL GERM CELL TUMOURS: GOOD SURVIVAL, BUT LONG-TERM SEQUELAE WITH IMPACT ON QUALITY OF LIFE
  1. M D Dragomir1,
  2. E Gruber1,
  3. V Ciurea2,
  4. I Tascu2,
  5. C Rosca3,
  6. M Savu3,
  7. C Radu1
  1. 1Department of Pediatric Oncology, Institute of Oncology, Bucharest, Romania
  2. 2Neurosurgery Department, Bagdasar-Arseni Hospital, Bucharest, Romania
  3. 3Radiotherapy Department, Institute of Oncology “Prof Dr Alex Trestioreanu”, Bucharest, Romania

Abstract

Objective To evaluate the outcome and long-term sequelae and the results of multimodal treatment in intracranial germ cell tumours.

Methods and Patients We retrospectively analysed 18 cases treated in our institute between January 1995 and December 2004. Patient characteristics: overt predominance of male cases (80%); age limits 8 and 19 years. The most frequent sites: stellar and pineal region (70%). The multidisciplinary treatment consisted of: surgery plus radiation therapy plus chemotherapy in 60% of patients; surgery plus radiation therapy in 40% of patients. Surgery performed: subtotal and quasitotal resections (66%), biopsies (33%). 70% of patients underwent radiation therapy on different fields (cranial, localised or craniospinal) and in varied doses (2000–5600 cGy).

Results/Discussions Overall survival evaluated by the Kaplan–Meier method: 84% at 5 years. The predominant onset symptoms were: headaches, visual disturbances (diplopia, strabismus, poor vision), diabetes insipidus and increased intracranial pressure. The long-term sequelae registered were: endocrine disturbances: diabetes insipidus (seven patients), global hypophysis impairment (five patients), hypothyroidism (one patient); ophthalmological impairments (eight patients): visual loss (four patients), diplopia (two patients); neurological disturbances: epilepsy (four patients), gait disturbances (two patients), hipoacusia (two patients), neurologena bladder (one patient).

Conclusions The current multidisciplinary therapeutic approach entails a minimisation of the late side effects by reducing the cranial irradiation efficient dose. The surgical approach limited to a diagnostic purpose obviates important endocrine and ophthalmological long-term sequelae. Lifetime follow-up with a medical care provider who is familiar with the early and late effects is highly recommended for continued health and wellbeing.

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