Germinoma natural history
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
Natural history
- Malignant transformation of primordial germ cells that inappropriately migrated during development (either failing to migrate into or out of an area) are the originators of germinomas. There is no histologic differentiation whereas nongerminomatous germ cell tumors display a variety of differentiation.
Complications
- Patients with intracranial tumors located in the basal ganglia perform poorly compared with those who have tumors in the suprasellar and pineal regions; they have lower short-term retention of visual and verbal stimuli and full-scale IQs.
- Larger irradiation volume and dose effect the following functions of the brain adversely:
- Intellectual functions
- Concept
- Executive function
- Memory
- Decline in neurocognitive function, and performance IQs
- Approximately more than 50% of patients may continue to suffer from endocrine abnormalities such as growth hormone deficiency, growth retardation, hypopituitarism, and hypothyroidism, and may require lifelong hormonal replacement therapy
- Due to surgical resection of tumor or due surgical biopsies the following complications may occur:
- Poor performance in psychosocial skills
- Behavioral dysfunction
- Financial difficulties
- Lower KPS scores following surgery have been associated with impaired neurocognitive function
- Complications related to chemotherapy may develop
- The surgical morbidity associated with pineal-region tumors is approximately 2-5%. Patients may suffer from the following:
- Transient movement abnormalities of eyes
- Ataxia
- Cognitive dysfunction
- The other complications that may present in patients with intracranial germ cell tumors are following:
- Brain atrophy
- Multifocal encephalomalacia
- Leukoencephalopathy
- Focal necrosis
- Cerebrovascular occlusion
- The incidence of secondary cancer is approximately 6%, in patients with intracranial tumors. The risk of death due to malignancy is approximately 16%. Radiation therapy and chemotherapy may both promote the development of secondary cancers such as acute myeloid leukemia and radiation-induced brain neoplasms.[1][2][3][4][5][6][7]
Prognosis
- Generally, germinomas are associated with an excellent prognosis. Intracranial germinomas have a reported 90% survival to five years after diagnosis.[8] The 10-year survival of germinomas is 70%.
The prognosis of various germ cell tumors is shown below in a tabular form:
| Type of tumor | 5-year survival rate |
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References
- ↑ Sugiyama K, Yamasaki F, Kurisu K, Kenjo M (2009). "Quality of life of extremely long-time germinoma survivors mainly treated with radiotherapy". Prog Neurol Surg. 23: 130–9. doi:10.1159/000210059. PMID 19329867.
- ↑ Sutton LN, Radcliffe J, Goldwein JW, Phillips P, Janss AJ, Packer RJ; et al. (1999). "Quality of life of adult survivors of germinomas treated with craniospinal irradiation". Neurosurgery. 45 (6): 1292–7, discussion 1297-8. PMID 10598695.
- ↑ Jinguji S, Yoshimura J, Nishiyama K, Aoki H, Nagasaki K, Natsumeda M; et al. (2013). "Factors affecting functional outcomes in long-term survivors of intracranial germinomas: a 20-year experience in a single institution". J Neurosurg Pediatr. 11 (4): 454–63. doi:10.3171/2012.12.PEDS12336. PMID 23373627.
- ↑ Acharya S, DeWees T, Shinohara ET, Perkins SM (2015). "Long-term outcomes and late effects for childhood and young adulthood intracranial germinomas". Neuro Oncol. 17 (5): 741–6. doi:10.1093/neuonc/nou311. PMC 4482856. PMID 25422317.
- ↑ Martens T, Rotermund R, Zu Eulenburg C, Westphal M, Flitsch J (2014). "Long-term follow-up and quality of life in patients with intracranial germinoma". Neurosurg Rev. 37 (3): 445–50, discussion 451. doi:10.1007/s10143-014-0544-8. PMID 24715277.
- ↑ Odagiri K, Omura M, Hata M, Aida N, Niwa T, Ogino I; et al. (2012). "Treatment outcomes, growth height, and neuroendocrine functions in patients with intracranial germ cell tumors treated with chemoradiation therapy". Int J Radiat Oncol Biol Phys. 84 (3): 632–8. doi:10.1016/j.ijrobp.2011.12.084. PMID 22420962.
- ↑ Chaudhry NS, Ahmad FU, Whittington E, Schatz N, Morcos JJ (2015). "Primary intrinsic chiasmal germinoma". J Neuroophthalmol. 35 (2): 171–4. doi:10.1097/WNO.0000000000000201. PMID 25621861.
- ↑ Packer RJ, Cohen BH, Cooney K, Coney K (2000). "Intracranial germ cell tumors". Oncologist. 5 (4): 312–20. PMID 10964999.