Early response to chemotherapy as an indicator for the management of germinoma-like tumors of the pineal and/or suprasellar regions |
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| Affiliation: | 1. Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan;2. Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan;3. Department of Pathology, Tohoku University Hospital, Sendai, Japan;4. Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan;1. St Christopher’s Hospital For Children, Department of Neurology, Philadelphia, PA, USA;2. Temple University, Department of Neurosurgery, 3401 N. Broad Street, Suite C540, Philadelphia, PA 19140, USA;3. Bromedicon, Inc., Yardley, PA, USA;1. Department of Radiation Oncology, The Prince of Wales Cancer Centre, Level 2, High Street, Randwick, NSW 2031, Australia;2. Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia;1. Department of Neurosurgery, Guangdong General Hospital, Neuroscience Institute, Guangdong Academy of Medical Sciences, 106 Zhangshan Er Road, Guangzhou 510080, China;2. Department of Neurosurgery, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China;1. Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province, China;2. Department of Outpatients, Air Force Command of Nanjing, Nanjing, China |
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| Abstract: | Recent advances in diagnostic imaging and experience with germinomas may allow for the differentiation of central nervous system germinomas from other tumors based on clinical information, without histological verification. We retrospectively analyzed clinically diagnosed germinoma-like tumors of the pineal and/or suprasellar regions. This was done to evaluate the efficacy of our strategy of defining germinoma-compatible tumors based on good responses to initial chemotherapy. The responses to chemotherapy and survival of 34 consecutive patients with germinoma-like tumors who underwent initial treatment from July 2001 to October 2010 were analyzed. The minimum apparent diffusion coefficient (minADC) value and proton magnetic resonance spectroscopy (MRS) were evaluated in recent patients. Twelve patients with histologically verified germinomas and 18 with germinoma-compatible tumors showed early logarithmic decreases in tumor volume in response to initial chemotherapy, typical low minADC values and typical MRS characteristics, including increased choline/creatine ratios, decreased N-acetylasparate/creatine ratios, and large lipid peaks. These patients had good progression-free survival. The other four patients, with histologically verified non-germinomas, showed no response to chemotherapy, and one patient with a pineoblastoma showed a similar minADC value and MRS characteristics to those of patients with germinomas. The response to initial chemotherapy can be used to distinguish germinoma-compatible tumors from non-germinoma in patients with germinoma-like tumors of the pineal and/or suprasellar regions. The evaluation of minADC and proton MRS are useful for distinguishing germinomas from other tumors. However, a subset of non-germinomas may show similar characteristics to germinomas. The benefit of bypassing unnecessary surgical intervention can be achieved, at least in Asian populations with a high incidence of germinomas. |
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| Keywords: | Apparent diffusion coefficient Chemotherapy Diagnosis Germinoma Magnetic resonance spectroscopy |
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