Indications for salvage surgery during treatment for intracranial germ cell tumors

  • Masayuki Kanamori
  • Toshihiro Kumabe
  • Mika Watanabe
  • Masashi Chonan
  • Ryuta Saito
  • Yoji Yamashita
  • Yoshikazu Ogawa
  • Yukihiko Sonoda
  • Teiji Tominaga
Clinical Study
  • 37 Downloads

Abstract

This study retrospectively reviewed our single institute experience to clarify the optimal indication and timing of salvage surgery. Retrospective analysis of 159 consecutive cases with germ cell tumors identified 20 cases with salvage surgery. These cases were classified based on the radiological response to neoadjuvant treatment before salvage surgery into increase (growing group, five cases), no change (stable group, seven cases), and decrease (shrinkage group, eight cases) in tumor size. Changes in tumor markers, histological findings, and the pattern of failure after salvage surgery were reviewed. Growing teratoma syndrome (GTS) is defined as enlargement of tumor consisting of mature teratoma after chemotherapy with normalization of tumor markers. In growing group, two cases presented GTS, whereas other three cases did not fulfill the criteria for GTS. All cases in stable and shrinkage group had elevated levels of tumor markers at presentation and decreased levels after neoadjuvant treatment. Histologically, sparse components of mature teratoma with extensive fibrosis were found in cases with GTS and seven of eight cases in shrinkage group, whereas mature teratoma without fibrosis was found in six of seven cases in stable group. Six cases recurred after salvage surgery. We identified three factors as risks for recurrence after salvage surgery, as follows: (1) growing lesion which did not fulfill the criteria for GTS, (2) non-normalized level of tumor marker before salvage surgery, and (3) residual germinoma component. In conclusion, salvage surgery is recommended for patients with GTS, or with normalized tumor markers in stable or shrinkage group.

Keywords

Salvage surgery Intracranial germ cell tumors Histological findings 

Notes

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Supplementary material

11060_2018_2827_MOESM1_ESM.pdf (373 kb)
Supplementary material 1 (PDF 373 KB)
11060_2018_2827_MOESM2_ESM.pdf (60 kb)
Supplementary material 2 (PDF 60 KB)

References

  1. 1.
    Friedman JA, Lynch JJ, Buckner JC et al (2001) Management of malignant pineal germ cell tumors with residual mature teratoma. Neurosurgery 48:518–522CrossRefPubMedGoogle Scholar
  2. 2.
    Kanamori M, Kumabe T, Saito R et al (2009) Optimal treatment strategy for intracranial germ cell tumors: a single institution analysis. J Neurosurg Pediatr 4:506–514CrossRefPubMedGoogle Scholar
  3. 3.
    Kochi M, Itoyama Y, Shiraishi S et al (2003) Successful treatment of intracranial nongerminomatous malignant germ cell tumors by administering neoadjuvant chemotherapy and radiotherapy before excision of residual tumors. J Neurosurg 99:106–114CrossRefPubMedGoogle Scholar
  4. 4.
    Ogiwara H, Kiyotani C, Terashima K et al (2015) Second-look surgery for intracranial germ cell tumors. Neurosurgery 76:658–661CrossRefPubMedGoogle Scholar
  5. 5.
    Weiner HL, Lichtenbaum RA, Wisoff JH et al (2002) Delayed surgical resection of central nervous system germ cell tumors. Neurosurgery 50:727–734CrossRefPubMedGoogle Scholar
  6. 6.
    Kanamori M, Kumabe T, Tominaga T (2008) Is histological diagnosis necessary to start treatment for germ cell tumours in the pineal region? J Clin Neurosci 15:978–987CrossRefPubMedGoogle Scholar
  7. 7.
    Kumabe T, Kusaka Y, Jokura H et al (2002) Recurrence of intracranial germinoma initially treated with chemotherapy only. No Shinkei Geka 30:935–942 (in Japanese)PubMedGoogle Scholar
  8. 8.
    Hirano T, Kumabe T, Murakami K et al (2001) Metachronous neurohypophysical immature teratoma occurring 10 years after total resection of pineal mature teratoma. Childs Nerv Syst 17:286–289CrossRefPubMedGoogle Scholar
  9. 9.
    Logothetis CJ, Samuels ML, Trindade A et al (1982) The growing teratoma syndrome. Cancer 50:1629–1635CrossRefPubMedGoogle Scholar
  10. 10.
    Kim CY, Choi JW, Lee JY et al (2011) Intracranial growing teratoma syndrome: clinical characteristics and treatment strategy. J Neurooncol 101:109–115CrossRefPubMedGoogle Scholar
  11. 11.
    Oya S, Saito A, Okano A et al (2014) The pathogenesis of intracranial growing teratoma syndrome: proliferation of tumor cells or formation of multiple expanding cysts? Two case reports and review of the literature. Childs Nerv Syst 30:1455–1461CrossRefPubMedGoogle Scholar
  12. 12.
    Aizer AA, Sethi RV, Hedley-Whyte ET et al (2013) Bifocal intracranial tumors of nongerminomatous germ cell etiology: diagnostic and therapeutic implications. Neuro Oncology 15:955–960CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Cunliffe CH, Fischer I, Karajannis M et al (2009) Synchronous mixed germ cell tumor of the pineal gland and suprasellar region with a predominant angiomatous component: a diagnostic challenge. J Neurooncol 93:269–274CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryTohoku University Graduate School of MedicineSendaiJapan
  2. 2.Department of NeurosurgeryKitasato University School of MedicineSagamiharaJapan
  3. 3.Department of PathologyTohoku University HospitalSendaiJapan
  4. 4.Department of NeurosurgeryMiyagi Cancer CenterNatoriJapan
  5. 5.Department of NeurosurgeryKohnan HospitalSendaiJapan
  6. 6.Department of NeurosurgeryYamagata University School of MedicineYamagataJapan

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