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Indications for salvage surgery during treatment for intracranial germ cell tumors

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Abstract

This study retrospectively reviewed our single institute experience to clarify the optimal indication and timing of salvage surgery. Retrospective analysis of 159 consecutive cases with germ cell tumors identified 20 cases with salvage surgery. These cases were classified based on the radiological response to neoadjuvant treatment before salvage surgery into increase (growing group, five cases), no change (stable group, seven cases), and decrease (shrinkage group, eight cases) in tumor size. Changes in tumor markers, histological findings, and the pattern of failure after salvage surgery were reviewed. Growing teratoma syndrome (GTS) is defined as enlargement of tumor consisting of mature teratoma after chemotherapy with normalization of tumor markers. In growing group, two cases presented GTS, whereas other three cases did not fulfill the criteria for GTS. All cases in stable and shrinkage group had elevated levels of tumor markers at presentation and decreased levels after neoadjuvant treatment. Histologically, sparse components of mature teratoma with extensive fibrosis were found in cases with GTS and seven of eight cases in shrinkage group, whereas mature teratoma without fibrosis was found in six of seven cases in stable group. Six cases recurred after salvage surgery. We identified three factors as risks for recurrence after salvage surgery, as follows: (1) growing lesion which did not fulfill the criteria for GTS, (2) non-normalized level of tumor marker before salvage surgery, and (3) residual germinoma component. In conclusion, salvage surgery is recommended for patients with GTS, or with normalized tumor markers in stable or shrinkage group.

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Authors and Affiliations

  1. Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Masayuki Kanamori, Masashi Chonan, Ryuta Saito & Teiji Tominaga

  2. Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

    Toshihiro Kumabe

  3. Department of Pathology, Tohoku University Hospital, Sendai, Miyagi, Japan

    Mika Watanabe

  4. Department of Neurosurgery, Miyagi Cancer Center, Natori, Miyagi, Japan

    Yoji Yamashita

  5. Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan

    Yoshikazu Ogawa

  6. Department of Neurosurgery, Yamagata University School of Medicine, Yamagata, Japan

    Yukihiko Sonoda

Authors
  1. Masayuki Kanamori
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  2. Toshihiro Kumabe
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  3. Mika Watanabe
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  4. Masashi Chonan
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  5. Ryuta Saito
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  6. Yoji Yamashita
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  7. Yoshikazu Ogawa
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  8. Yukihiko Sonoda
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  9. Teiji Tominaga
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Corresponding author

Correspondence to Masayuki Kanamori.

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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Kanamori, M., Kumabe, T., Watanabe, M. et al. Indications for salvage surgery during treatment for intracranial germ cell tumors. J Neurooncol 138, 601–607 (2018). https://doi.org/10.1007/s11060-018-2827-3

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  • DOI: https://doi.org/10.1007/s11060-018-2827-3

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