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Prognostic factors and therapeutic problems of
primary intracranial choriocarcinoma/germ-cell tumors with high levels of HCG
Shinoda J, Sakai N, Yano H, Hattori T, Ohkuma A, Sakaguchi H
Department of Neurosurgery, Gifu University School of Medicine,
Gifu, Japan. junshino@cc.gifu-u.ac.jp
Objective. Primary intracranial choriocarcinoma (PICCC)/germ-cell tumors
(GCTs) with high levels of human chorionic gonadotropin (HCG) (PICCC/GCTs with
HL-HCG) are rare and malignant.
The goal of this study was to report our 3 cases of PICCC/GCTs with HL-HCG and
to review the literature to elucidate the clinical problems and prognostic
factors and to discuss the therapeutic modalities of this rare tumor.
Methods. Survival was analyzed in 66 previously reported PICCC/GCTs
with HL-HCG including our 3 cases, of which the clinical results have been
described in the literature since 1975.
In the 66 cases (mean age: 12.1 years; male/female: 45/21), 35 were verified
histologically as pure choriocarcinoma, 23 were as mixed GCTs with
choriocarcinoma element, and 8 were not verified as including choriocarcinoma
element histologically but with very high HCG levels.
Significance of the differences among survival curves concerning each parameter
(age, sex, tumor location, serum HCG/beta-HCG level, precocious puberty, extent
of surgery, radiotherapy, chemotherapy, mixture of other non-germinomatous GCT
elements and extraneural metastasis) was tested using univariate and
multivariate analyses.
Results. The median survival time and the 1- and 2-year survival rates
were 22 months, 61.2% and 49.8%, respectively.
In univariate analysis, male, subtotal removal or more, radiotherapy and
chemotherapy were revealed to be significantly good prognostic factors.
However, suprasellar region and tumor hemorrhage were poor prognostic
factors.
Multivariate analysis showed that extent of surgery, radiotherapy and
chemotherapy were independent prognostic factors.
Conclusions. Although, we should mind the limitations of this study
design because of case selection bias, different treatment protocols and
incomplete follow-up of patients, this study led the following results and
suggestive conclusions.
Tumor hemorrhage and progressive extraneural and cerebrospinal fluid metastasis
were characteristic clinical problems of PICCC/GCTs with HL-HCG.
In the cases with extremely elevated levels of HCG, biopsy for histological
diagnosis may be no longer needed.
Initial biopsy and radiotherapy may lead to tumor hemorrhage.
To prevent tumor hemorrhage, gross tumor removal followed by radiotherapy and
chemotherapy should be aimed for.
A few courses of chemotherapy before surgery may prevent metastasis.
Stereotactic radiotherapy and high dose chemotherapy may be promising options
for treatment.
PMID: 15015791 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15015791
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