gms | German Medical Science

Objective: CNS germinoma is a very rare, malignant germ cell tumour, that predominantly occurs in adolescents. It only accounts for approximately 1–4 of all intracranial tumors. Germinomas are very radiosensitive, cure rates of up to 90% have been described

Methods: 33 out of 39 patients diagnosed with central nervous system germinoma were evaluated, focusing on treatment results over a course of 5–10 years as well as the patients prognosis depending on the diagnostic process (biopsy vs. tumour resection) considering clinical state and quality of life. We used the EORTC QLQ C30 questionnaire as well as the Modified Rankin Scale.

Results: At follow-up six patients had already deceased since first being diagnosed. The 5-year survival and 10-year survival was 86.2% and 82.1%. 32 patients were treated via adjuvant cranial radiotherapy, 25 of these patients also received radiotherapy of the spinal system. One patient was treated with radiotherapy 2 months after the diagnosis. 11 patients were treated with chemotherapy right after the initial diagnosis, in two cases chemotherapy was performed in case of recurrent disease. According to the modified Rankin scale, nine patients did not suffer from any considerable postoperative disability, 8 patients had a slight disability, 5 patients suffered from moderate disability, 2 patients were classified as disabled and 2 patients were classified as severely disabled. Only one patient did not suffer from any symptoms. As far as the diagnostic means tumour biopsy (n = 14) versus tumour resection (n = 17) are concerned, the group of patients that was diagnosed via stereotactic biopsy shows a slightly better outcome.

Conclusions: Despite good therapy options with high cure rates, a considerable decrease of the quality of life could be observed in the surviving patients. This development was mainly due to neurocognitive, hormonal and psychosocial dysfunctions. We found a strong connection between radiotherapy and neurocognitive impairement. With adequate treatment including radiotherapy as its main modality, the central nervous system germinoma has a good prognosis concerning mortality and relapse risk. However, most patients suffer significantly from the long-term side effects of radiation. By means of individualized therapy, it should therefore be attempted to balance the radiation dose, keeping it as low as possible without provoking relapses. The surgical teqchnique should be chosen individually according to localisation and morphology of the tumor.