Tumours of the pineal region: retrospective study about 40 cases

##plugins.themes.academic_pro.article.sidebar##

Published Sep 30, 2010
Download
pdf
Vol. 88 No. 10 (2010): Issue Oct 2010

##plugins.themes.academic_pro.article.main##

Chiraz Nasr Ben Ammar
Dorra Mnif
Bacem Belghith
Lotfi Kochbati
Hatem Frikha
Walid Gargouri
Mounir Besbes
Mansour Ben Abdallah
Mongi Maalej

Abstract

Background : the tumours of the pineal region are rare brain tumours, most common in children and characterized by a large clinical and histologic polymorphism.
Aim: to assess the outcome and prognostic factors of 40 patients with primitive pineal region tumours treated at the department of radiotherapy of Salah Azaiz institute.
Methods: between January 1977 and December 2000, 40 patients received radiotherapy. There were 22 adults and 18 children (age < 16 years). The mean age was 20.4 years and sex ratio was 2.07. Histologic diagnosis was confirmed in 11 cases; 16 patients had a CT evaluation after 20 Gy radiotherapy and in 13 cases diagnosis was performed with CT aspects ± germinal tumour markers. Target volume varied; 10 had craniospinal irradiation, 16 had local irradiation and 14 had whole brain irradiation with a boost at the tumour bed. Chemotherapy was proposed for metastases and recurrent diseases.
Results: survival rates were 87% at 2 years and 74, 5% at 5 years. For children, survival rates were 88% at 2 and 4 years. Eight patients (20%) failed locally and 5 patients (12.5%) had metastasis. Age, performance status and large fields of radiotherapy seem to be associated with prognosis and survival.
Conclusion: Pineal tumours and especially germinal tumours are chemosensitive and radiosensitive, care of these tumours is
multidisciplinary involving surgery, chemotherapy and radiotherapy. From our study and a review of the literature, we tried to find a therapeutic strategy for tumours of the pineal region.

Keywords:

Pineal region tumours, Radiotherapy, Chemotherapy, Surgery

##plugins.themes.academic_pro.article.details##

References

  1. Habrand J.L, Abdulkarim B, Beaudré A, El Khouri M, Kalifa C. La determination des volumes-cibles en radiothérapie pédiatrique: application aux tumeurs cérébrales. Cancer/ Radiothérapie 2001; 5 : 711-9.
  2. Fauchon F, Jouvet A, Alapetite C, Fevre-Montange M. Classification and treatment of tumours of the pineal region. EMC-Neurologie 2005; 2 : 596-617.
  3. Konovalov AN, Pitskhelauri DI. Principles of treatment of the pineal region tumors. Surg Neurol 2003; 59 : 250-68.
  4. Tamaki N, Yin D. Therapeutic strategies and surgical results for pineal region tumours. Journal of Clinical Neuroscience 2000; 2 : 125-128.
  5. Blond S. Tumeurs du 3ème ventricule, du ventricule lateral et des stuctures adjacentes : Cohadon F, eds. Tumeurs du système nerveux central et de ses enveloppes. Paris Medecine Sciences : Flammarion, 1989 : 261-76.
  6. Fuller BG, Kapp DS, Cox R. Radiation therapy of pineal region tumours: 25 new cases and a review of 208 previously reported cases. Int J Radiat Oncol Biol Phys 1993; 28 : 229-45.
  7. Heideman RL, Packer RJ, Albright LA, Freeman CR, Rorke LB. Tumors of the central nervous system. Dans: Pizzo PA, Poplack DG, eds. Principles and practice of pediatric oncology. Philadelphia: Lippincott-Raven Publishers, 1997 : 674-7.
  8. Jomaa R, Kendall BE. Diagnosis and management of pineal tumors. J Neurosurg 1983; 58 : 654-65.
  9. Levin VA, Leibel SA, Gutin PH. Neoplasms of the central nervous system. Dans: De Vita VT, Hellman JS, Rosenberg SA, eds. Cancer: principles and practice of oncology; 6th edition, 2001 : 2142-5.
  10. Packer RJ, Sutton LN, Rosenstock JG et al. Pineal region tumors of childhood. Pediatrics 1984; 74 : 97-102.
  11. Régis J, Bouillot P, Figarella-Branger D et al. Les biopsies stéréotaxiques des tumeurs de la région pinéale. Réflexions sur leur risque et leur rendement à propos de 370 cas. Neurosurgery 1994; 40 : 3-9.
  12. Régis J, Bouillot P, Rouby-Volot F, Figarella-Branger D, Dufour H, Peragut JC. Pineal region tumors and the role of stereotactic biopsy : Review of the mortality, morbidity and diagnostic rates in 370 cases. Neurosurgery 1996; 39 : 907-14.
  13. Chao CK, Lee ST, Lin FJ, Tang SG, Leung WM. Multivariate analysis of prognostic factors in management of pineal tumor. Int J Radiat Oncol Biol Phys 1993; 27 : 1185-91.
  14. Dearnaley DP, A'Hern RP, Whittaker S, Bloom HJ. Pineal and CNS germ cell tumors: Royal Marsden Hospital experience 1962- 1987. Int J Radiat Oncol Biol Phys 1990; 18 : 773-81.
  15. Edwards MSB, Hudings RJ, Wilson CB, Levin VA, Wara WM. Pineal region tumors in children. J Neurosburg 1988; 68 : 689-97.
  16. 16.Haddock MG, Shild SE, Scheithauer BW, Schomberg PJ.Radiation therapy for histologically confirmed primary central nervous system germinoma. Int J Radiat Oncol Biol Phys 1997; 38 : 915-23.
  17. Shild SE, Scheitauer BW, Schomberg PJ et al. Pineal parenchymal tumors: Clinical, pathologic and therapeutic aspects. Cancer 1993; 72 : 870-80.
  18. Wolden SL, Wara WM, Larson DA, Prados MD, Edwards MSB, Sneed PK. Radiation therapy for primary intracranial germ-cell tumors. Int J Radiat Oncol Biol Phys 1995; 32 : 943-9.
  19. Shirato H, Aoyama H, Ikeda J et al. Impact of margin for target volume in low-dose involved field radiotherapy after induction chemotherapy for intracranial germinoma. Int J Radiat Oncol Biol Phys 2004; 60 : 214-7.
  20. Shirato H, Nishio M, Sawamura Y et al. Analysis of long-term treatment of intracranial germinoma. Int J Radiat Oncol Biol Phys 1997; 37 : 511-5.
  21. Buckner JC, Peethambaram PP, SmithSon WA, Groover RV, Schomberg PJ, kimmel DW et al. Phase II trial of primary chemotherapy followed by reduced-dose radiation for CNS germcell tumors. J Clin Oncol 1999; 17 : 933-40.
  22. Amant FF, Bienayme J, Bargy F, Delons E, Caillaud JM, Lemerle J. Les tumeurs germinales malignes de l'enfant. Arch Fr Pediatr 1983;40 : 117-22.
  23. Armedola BE, Wolf A, Coy SR, Amendola MA, Eber D. Pineal tumours: analysis of treatment results in 20 patients. J Neurosurg 2005; 102 : 175-9.
  24. Glanzmann CH, Seelentag W. Radiotherapy for tumours of the pineal and suprasellar germinomas. Radiotherapy and Oncology 1989; 16 : 31-40.
  25. Huh SJ, Kyung HS, IL Han K, Yong CH, Sung WH, Charn IL P. Radiotherapy of intracranial germinomas. Radiotherapy and Oncology 1996; 38 : 19-23.
  26. Shibamoto Y, Oda Y, Yamashita J, Takahashi M, Kikuchi H, Abe M. The role of cerebrospinal fluid cytology in radiotherapy planning for intracranial germinoma. Int J Radiat Oncol Biol Phys 1994; 29 : 1089-94.
  27. Kersh CR, Constable WC, Eisert DR et al. Primary central nervous system germ cell tumors. Effect of histologic confirmation on radiotherapy. Cancer 1988; 61 : 2148-52.
  28. Allen JC, DaRosso RC, Donahue B, Nirenberg A. A phase II trial of preirradiation carboplatin in newly diagnosed garminoma of the central nervous system. Cancer 1994; 74 : 940-4.
  29. Allen JC, Kim JH, Packer RJ. Neoadjuvant chemotherapy for newly diagnosed germ-cell tumors of the central nervous system. J Neurosurg 1987; 67: 65-70.
  30. Calugaru V, Taillibert S, Lang P, Simon J-M, Delattre J-Y, Mazeron J-J. Chimiothérapie néoadjuvante suivie d'une radiothérapie adaptée à la réponse tumorale dans les tumeurs germinales séminomateuses du système nerveux central : expérience de l'hôpital de la pitié-salpêtrière et revue de la littérature. Cancer / Radiother 2007;11: 122-128
  31. Onoyama Y, Ono K, Nakajima T, Hiraoka M, Abe M. Radiation therapy of pineal tumors. Radiology 1979; 130 : 757-60.
  32. Balmaceda C, Heller G, Rosenblum M et al. Chemotherapy without irradiation-A novel approach for newly diagnosed CNS germ cell tumors: Results of an International Cooperative Trial. J Clin Oncol 1996; 14 : 2908-15.
  33. Agranat P, Jedynak P, Epardeau B, Extra JM, Mignot L. Les tumeurs germinales cérébrales de l'adulte. Etude rétrospective de 19 cas. Bull Cancer 1995; 82 : 650-9.
  34. Barnazelli MC, Patte C, Bouffet E, Couanet D, Habrand JL, Portas M et al. Nonmetastatic intracranial germinoma : the experience of the French Society of Pediatric Oncology. Cancer 1997; 80 : 1792-7.
  35. Matsutani M. Combined chemotherapy and radiation therapy for CNS germ cell tumors-the Japanese experience. J Neurooncol 2001; 54 : 311-6.
  36. Eom KY, Il Han K, Charn Il P, Hak Jae K, Jin Ho K. Upfront chemotherapy and involved-field radiotherapy results in more relapses than extended radiotherapy for intracranial germinomas: modification in radiotherapy volume might be needed. Int j Radiat Oncol Biol Phys 2008; 71 : 667-671.
  37. Alapetite C, Carrie C, Brisse H, Thiesse P, Habrand JL, Gaboriaud , et al. On behalf of the SFOP. (Société Française d'Oncologie Pédiatrique).Patterns of relapse following Carboplatin-based chemotherapy and focal irradiationof intracranial germinoma :the SFOP experience. Neuro-Oncol 2003; 5 : 25
  38. Brandes A.A, Pasetto L.M, Monfardini S. The treatment of cranial germ cell tumours. Cancer treatment reviews 2000; 26 : 233-242.
  39. Ashley DM, Longee D, Tien R et al. Treatment of patients with pineamoblastoma with high dose cyclophosphamide. Med Pediatr Oncol 1996; 26 : 387-92.
  40. Jakacki RI, Zeltzer PM, Boyett JM et al. Survival and prognostic factors following radiation and/or chemotherapy for primitive neuroectodermal tumors of the pineal region in infants and children: a report of the Children's Cancer Group. J Clin Oncol 1995; 13 : 1377-83.