The Study Of Treatment Strategies Of Pineal Region Germ Cell Tumors

Objective:To study and explore the optimal treatment strategy for the pineal region germ cell tumors,and evaluate the effect of the treatment strategy.Methods:Between September 2009 and December 2015, in a retrospective analysis the clinical data of a total of 33 consecutive pineal region germ cell tumors patients were treated by endoscopic third ventriculostomy(ETV) and tumor biopsy in Chinese People's Liberation Army General Hospital.The pure endoscopic group has 28 cases with the pathological diagnosis were germinoma or mixed germ cell tumors, which were treated with PEB(cisplatin,etoposide,bleomycin) chemotherapy after ETV.The rest 5 cases which were diagnosis wih teratoma and relapsed york sac tumor had second craniotomy surgery and tumor resection after ETV. All the cases had routine follow-up after the final surgery. A compare of the two groups postoprative complications and the impact of the treatment strategy on patients'survival rate were retrospectively analyzed.Resuits:All the patients underwent the ETV and tumor biopsy successfully.The patients' age ranged 2 to 28 years,mean age 15.8 years; the preoperative mean tumors volumes were 8.42cm3.In the pure endoscopic group,2 cases (7.1%) had the postoprative short-term fever,but no long-term complications. In the craniotomy group 2 cases developed the short-term mutism, lcase developed the visual field defect. The short-term(<3 months) morbidity rate was (60%). However 1 case still had visual field defect after 6 months follow-up, which made the long-term morbidity rate was 20%. The mean follow-up time was 36.4 months (range,3-75 months).There were 25 cases (75.8%) germinoma and Non-germinomatous germ cell tumors (NGGCTs) 8 cases (24.2%) by the pathological diagnosis. The 5-year survival rate of germinoma and NGGCTs were 90.9% and 58.3% (p=0.2244)Conclusions:For pineal region germ cell tumors, the optimal treatment strategy of simultaneous endoscopic third ventriculostomy and tumor biopsy can be used to manage non-communicating hydrocephalus and it may avoid the potential postoprative complications of ventriculoperitoneal shunt and the initial craniotomy treatment of germinoma.The PEB chemotherapy,radiothreapy or second craniotomy surgey could be applied in the treatment after the pathological diagnosis, and achieved a better result of treatment. It will become a routine treatment strategy for pineal germ cell tumors with non-communicating hydrocephalus.