Preliminary observations for a new treatment in children with primary intracranial yolk sac tumor or embryonal carcinoma

Report of five cases

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✓ The authors evaluated the effect of adjuvant therapy (preoperative chemotherapy combined with radiotherapy) followed by radical tumor removal in the treatment of children with primary intracranial yolk sac tumor, embryonal carcinoma, or mixed germ cell tumors containing yolk sac tumor components.

Between 1988 and 1995, five consecutive patients were treated with adjuvant therapy followed by total tumor removal. The diagnosis was based on markedly elevated concentrations of serum α-fetoprotein (AFP) and/or β-human chorionic gonadotropin (β-HCG) in four children and the results of biopsy sampling in one child. The chemotherapy regimen consisted of cisplatin (20 mg/m2) and etoposide (60 mg/m2) daily for 5 days (one course) given three times at 4-weeks intervals. Radiotherapy consisted of 30 to 40 Gy to the whole brain or an area including all ventricles and a 15- to 20-Gy boost to the tumor site. Spinal radiation of 25 Gy was added in one patient. In all patients the serum level of AFP and β-HCG gradually decreased during the adjuvant therapy and disappeared completely on its completion. In two of the five patients the tumor disappeared as well. In the other three patients the tumor size was moderately or markedly reduced and the remaining tumor was totally removed; there were no neurological deficits. Chemotherapy was maintained after the initial treatment and was repeated every 2 to 4 months for less than 2 years. All children are alive and well without recurrence at 33 to 118 months (average 88 months) after the start of adjuvant therapy.

Our preliminary results indicate that adjuvant therapy consisting of combination chemotherapy with cisplatin and etoposide and concomitant radiotherapy, followed by removal of the tumor, is highly effective in the treatment of pediatric patients with primary intracranial yolk sac tumor, embryonal carcinoma, or mixed germ cell tumors containing yolk sac tumor components.

Article Information

Address reprint requests to: Yukitaka Ushio, M.D., Ph.D., Department of Neurosurgery, Kumamoto University Medical School, 1–1–1, Honjo, Kumamoto, Kumamoto 860–8556 Japan. email: yushio@kaiju.medic.kumamoto-u.ac.jp.

© AANS, except where prohibited by US copyright law.

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    Left: Admission enhanced computerized tomography scan obtained in a 9-year-old girl revealing a large tumor in the pineal region. Her serum AFP was 4300 ng/ml and β-HCG was 1.5 ng/ml. Center: Enhanced computerized tomography scan in the same child revealing a small residual tumor after two courses of PE therapy and concomitant RT. Serum markers were negative. The remaining tumor was removed. Right: Gadolinium-enhanced MR image obtained 9.5 years posttherapy, demonstrating no tumor recurrence. The patient is attending high schoool and has no neurological deficits.

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    Left: Admission gadolinium-enhanced MR image obtained in a 5-year-old girl revealing a large tumor in the suprasellar region. Her serum AFP was 450 ng/ml and β-HCG was 1.5 ng/ml. Center: Enhanced MR image demonstrating a residual tumor after three courses of PE therapy and concomitant RT. Serum tumor markers were negative. The residual tumor was totally removed. Right: Enhanced MR image obtained 7 years posttherapy demonstrating no tumor recurrence. The patient is receiving hormone replacement therapy and attending a school for handicapped children with a moderate degree of mental disturbance.

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    Left: Admission gadolinium-enhanced MR image obtained in a 9-year-old boy revealing a large tumor in the pineal region extending to the left basal ganglia. His serum AFP was 2530 ng/ml. Center: Enhanced MR image after three courses of PE therapy and concomitant RT showing residual tumor. His serum AFP was negative. The residual tumor was totally removed. Right: Enhanced MR image obtained 2 years and 7 months posttherapy demonstrating no tumor recurrence. The patient is attending a junior high school and manifests no neurological deficits.

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