Intracranial Germ Cell Tumour: Experience of a Singaporean Institution Over 11-Year Period

LC Wong, TL Yang, F Gao, AM Tan, VK Sethi, EJ Chua
Correspondence: Dr Wong Lea Choung, trdwlc@nccs.com.sg

ABSTRACT
Background Intracranial germ cell tumours (IGCT) are rare. We present our experience in Therapeutic Radiology Department, National Cancer Centre, Singapore.
Methods A retrospective study was conducted through case notes review on 25 patients with IGCT referred between January 1988 and January 1999.
Results The median age at diagnosis was 13 years (range 6-22). The tumours were mainly pineal germinoma (72%). Median follow-up for living patients was 2.57 years (range 0.12-10.8). Median radiotherapy (RT) dose to whole brain, primary site and spine was 35.3,54 and 30 Gys respectively. Four to six cycles of BEP or JEB chemotherapy (CM) were given in 10 patients. As for the whole study group, the seven-year overall survival (OS) and recurrence-free survival (RFS) were 86% (95% CI 72-100) and 78% (95% CI 60-100) respectively. The 10-year OS and RFS were 65% (95% CI 36-100) and 78% (95% CI 60-100) respectively. The germinoma group had 75% 10-year OS and 86% 10-year RFS. Mixed germinoma and non-germinoma germ cell tumours (NGGCT) group had 50% one-year RFS and 44% two-year OS. Acute side-effects of RT and CM were minimal. There was no statistically significant difference in side-effects when treatment modalities were compared.
Conclusion In the treatment of intracranial germinoma, we recommend biopsy and CSRT. Primary chemotherapy (+/- low-dose cranial RT) should be used in the protocol or clinical trial settings. Chemo-radiotherapy is recommended for mixed germinoma and NGGCT. A multicentre trial is needed to address various controversial issues.

Keywords: Chemotherapy, Craniospinal radio-therapy, Germinoma, Intracranial germ cell tumour, Singaporean
Singapore Med J 2002; 43(4): 182-188