GERM-07. HISTOLOGICAL DIAGNOSES OF BIFOCAL DI-NEGATIVE AND TUMOR MARKER-NEGATIVE TUMORS; AND OUTCOME AFTER NON-CSI STRATEGY FOR CYTOLOGY-POSITIVE GERMINOMAS IN JAPAN. HOMEWORK AFTER DELPHI CONSENSUS

摘要

The Delphi consensus statements on the management of intracranial germ cell tumors (GCTs) (Murray MJ, et al. Lancet Oncology 16:e470-e477, 2015) left some homework unanswered. One of them was the histological diagnosis of bifocal (pineal and neurohypophyseal), diabetes insipidus (DI)-negative and tumor marker (HCG and AFP) –negative tumors; and the other was justification of craniospinal irradiation (CSI) for CSF cytology-positive germinomas. We performed a survey for 54 institutes in Japan and analyzed the clinical information, histological diagnoses, treatments, and outcome to answer those questions. There were six (6.9%) out of 88 histologically verified bifocal, DI and tumor marker-negative cases that was not germinoma, including two germinomas with teratomatous component, two immature teratomas, an embryonal carcinoma and a granuloma. Among 80 cases with positive CSF cytology, 26 received CSI and 53 received cranial irradiation. The 5 year PFSs were similar (90% and 82%, respectively). However, there was a difference in the pattern of failure; two cases (7.7%) with CSI developed recurrence within the irradiated fields while 6 cases (11.3%) treated with cranial irradiation developed spinal recurrences and two of them were dead because of the recurrent tumors.