Radiation therapy for pineal and suprasellar germ cell tumors

Abstract

Radiation therapy (XRT) was used in the treatment of 25 patients with tumors of the pineal and suprasellar locations. A tissue diagnosis was obtained before XRT in 5 patients and 20 were irradiated without histologic verification. The overall survival rate is 80% (76% with no evidence of disease[NED]). Megavoltage XRT was delivered to the entire neuraxis in 22 patients and 86% (19/22) are alive from 4-88 mo. (median, 30 mo.) after treatment. In 2 of 3 patients treated only to local fields, tumor recurred in th spine; both are dead of disease. Biopsy-proven germinomas and multiple midline tumors responded favorably to XRT, whereas solitary pineal tumors and teratomas with marker positivity (human chorionic gonadotropin, .alpha.-fetoprotein) did not respond as well. The endocrinologic presentation, tumor marker status and early response to radiation measured on computed tomography are useful means for selecting patients for radiation therapy.