Abstract
Between 1971 and 1988, thirty-one patients were treated with radiation for confirmed or suspected intracranial germinoma. From 1971 to 1978, thirteen patients received 20-50 Gy/13f-28f in the primary tumor site. The field sizes ranged from 4×5 cm to 9×13cm, but were mostly 8×8cm. After 1979, eighteen patients were treated with a total dose of 50 Gy/28 f over 6 weeks, 30 Gy/18 f over 4.5 weeks, delivered to the whole brain, and 20Gy/10 f over 2.5 weeks to the primary tumor site. The overall 5-and 10-year survival rates of the 31 cases in which radiotherapy was completed were 93.0% and 84.3%. The survival rates of patients treated with only regional irradiation were 84.6% at 5 years and 76.9% at 10 years. On the other hand the survival rates of patients treated with whole brain irradiation was 100% at 5 years. Intracranial relapse occurred in four patients whose treatment was limited to primary tumor site and/or tumor dose was less than 40 Gy over 5 weeks. Prophylactic spinal irradiation was undertaken in 10 patients. Prophylactic irradiation of the spinal axis (20 Gy in 2.5 weeks) was carried out in patients exhibiting abnormal cerebrospinal fluid (CSF): positive cytology for tumor cells, or increased protein and cell-count levels. In a 15-year-old patient who had not been treated despite positive CSF findings, lumbar spinal relapse occurred after 2.5 years. Except for this case there were no spinal metastases regardless of radiotherapy. On the basis of our results, we recommend whole-brain irradiation to 30Gy over 4.5 weeks plus a boost of 20Gy over 2.5 weeks to the primary site and prophylactic spinal irradiation for patients exhibiting abnormal CSF.
