Purpose/Objective(s): To report secondary tumor development in patients treated with radiation therapy for intracranial germ cell tumors within our institution. Materials/Methods: A retrospective review was carried out on pediatric patients treated for intracranial germ cell tumors with radiation therapy at our institution from 1983 to 2006 (n=13). Six patients had germinomas (G); and 7 patients had non- germinomatous germ cell tumors (NG).Results: Median follow-up for the 13 patients reviewed was 9.7 years (range 8.32 months - 16.1 years). A gross total resection was utilized in 3 G and 2 NG patients, whereas 2 G and 4 NG patients underwent subtotal resection. One G patient underwent a biopsy only. One NG patient did not have biopsy or surgery. Of the 6 G patients 3 received CSI while 3 received local filed irradiation. All NG patients received CSI. 1 G and 5 NG patients received chemotherapy per COG studies.Five- and 10-year disease free survival (DFS) for all patients was 92% and 85%. 5 G and 6 NG patients were free of disease at 10 years. Two patients developed a recurrence: A G patient who had received CSI, and a NG patient treated with CSI and chemotherapy. Three of 13 patients (23%) developed a secondary tumor: one intracranial low grade glioma diagnosed 20 years after CSI for a G , one intracranial meningioma diagnosed 16 years after CSI in a NG patient, and one osteochondroma of the right posterior 2nd rib diagnosed 6 years in a G patient who had received CSI. Of the three patients with a secondary tumor, only one patient (who developed a meningioma) had received chemotherapy. Long-term complications of the whole group included endocrinopathy (n=10), neurocognitive delay (n=6), sensorineural hearing loss (n=4), visual deficits (n=8), and orthopedic complications (n=3).Conclusions: Patients with intracranial germ cell tumors are at risk for secondary tumors due to high survival rates achieved with treatment. In this small series of intracranial germ cell tumors, secondary tumors were observed in 23%. Interestingly, the time interval to development of osteochondroma was rather short at six years. This short time interval between radiation and development of osteochondromas has been previously reported in larger case-series in patients treated with total body irradiation.
Botros, M,
Secondary Tumors in Long-term Follow-up of Patients Treated for Intracranial Germ Cell Tumors. Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL.
http://archive.rsna.org/2014/14042716.html
