gms | German Medical Science

27. Deutscher Krebskongress

Deutsche Krebsgesellschaft e. V.

22. - 26.03.2006, Berlin

Germ Cell Tumours of the Central Nervous System – a multidisciplinary team approach

Meeting Abstract

  • corresponding author presenting/speaker Gabriele Calaminus - University Hospitals, Duesseldorf, Düsseldorf, Deutschland
  • J. Nicholson - University Hospitals, Cambridge
  • D. Frappaz - University Hospitals, Lyon
  • M.L. Garre - University Hospitals, Genova
  • R. Kortmann - University Hospitals, Leipzig
  • C. Alapetite - Institute Curie, Paris
  • U. Ricardi - University Hospitals, Turin
  • F. Saran - Royal Marsden, London
  • U. Göbel - University Hospitals, Duesseldorf

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocIS020

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter:

Veröffentlicht: 20. März 2006

© 2006 Calaminus et al.
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Intracranial germ cell tumours (GCTs) are rare and predominantly diagnosed between the age of 6 and 14 years in males. They are typically midline tumours of the suprasellar or pineal region. They present with raised intracranial pressure, endocrinological and opthalmological impairment. Diagnosis is based on: clinical symptoms, markers in serum and CSF, neuroimaging, cytological (CSF) and histological confirmation. The elevation of AFP in serum/ CSF (> 25 ng/ml) is typical for a yolk sac tumor component and ß-HCG (> 50 IU/L) for the appearance of a choriocarcinoma. All these aspects are strongly recommended to be examined by a multidisciplinary team (neurosurgeon, oncologist, neuro-radiologist, pathologist) before treatment (including surgery) is started . It is essential to try to perform the correct staging and diagnosis before treatment decisions are made because this can positively influence the results of therapy and outcome. About 25% of all pediatric CNS GCT present as tumors with more than one histology. Histological types are: germinoma and non-germinoma, such as yolk sac tumors, choriocarcinoma, embryonal carcinoma and as so called benign tumors; teratoma. Therapy and prognosis depend on the component with the highest malignancy and on dissemination. It can be expected that about 15% of the germinoma and 20% of the non-germinomatous tumors are metastatic. Bifocal disease appear in about 20% and are treated as non-metastatic. Within the last 20 years craniospinal (CS) irradiation (RT) has been the treatment in Germinoma. With 30 to 24 Gy to the CS axis and a tumor boost between 20 and 16 Gy it is possible to cure about 90% of the patients. The other attempt to treat germinoma is chemotherapy (Carbo-PEI) and local RT (non-metastatic). With this approach survival rates are about 85%. In non-germinoma a combined treatment with Cisplatin as the leading agent is used (PEI) in combination with focal RT or CS RT in respect to dissemination. Event-free survival is around 70%. Incomplete staging is a major risk factor in germinoma. With combined treatment and focal RT mainly ventricular relapses are diagnosed. AFP-level at diagnosis may play an important role for prognosis of non-germinoma. Analysis within the SIOP CNS GCT protocol reveals a prognostic impact of a tumor residue after the end of treatment. In the fourthcoming SIOP CNS GCT II protocol these findings will be addressed. Supported in part by Deutsche Krebshilfe