Intracranial Germ Cell Tumors of the Pineal Region in a Middle-income Country: A Case Series and Literature Review
Jose Maria Benítez-Salazar1, Maria Gaspar-Verduzco2, Fernando Jose Cabrera-Romero2, Juan Carlos Perez-Garcia1, Jorge Chamorro-Chamorro2
1Universidad Popular Autonoma del Estado de Puebla, 2National Cancer Institute of Mexico
Objective:

Describe the clinical characteristics, treatment approaches, and outcomes of patients with Intracranial germ cell tumors (iGCTs) treated at a single national reference institution in Mexico over a 24-year period, and to assess the variability in treatment regimens and its potential impact on survival and treatment-related toxicity. 

Background:

iGCTs are rare central nervous system neoplasms, accounting for approximately 1–3% of all brain tumors. They are classified as germinomas or non-germinomatous germ cell tumors (NGGCTs). These tumors exhibit high sensitivity to chemotherapy and radiotherapy (RT).

There are no standardized guidelines for the treatment of patients with iGCTs.  They requiered multimodal treatment with surgical resections, RT and chemotherapy.  Despite the favorable prognosis of iGCTs, the treatment can lead to significant side effects that can affect the quality of life of the patients. 

Design/Methods:
NA
Results:
Five patients were included. The mean age was 18.6 years (14-20). The most common presenting symptoms included headache, visual disturbances, and altered mental status. Three patients presented with elevated tumor markers (AFP or HCG) at baseline. Two cases were NGGCTs and three iGCTs. All patients received multimodal therapy consisting of Etoposide/Platinum-based chemotherapy followed by radiation(20 Gy to 90 Gy). Four out of five patients achieved a Complete Response, while one had an initial Partial Response requiring further treatment with Bleomycin and Vinblastine. Post-treatment complications were reported in three patients: two suffered a stroke, and one developed a meningioma.
Conclusions:

It is essential to improve and standardize treatment regimens to minimize variability in chemotherapy cycles and radiotherapy dosing. The implementation of advanced technologies such as intensity-modulated radiotherapy (IMRT) may help reduce radiation-associated side effects and enhance disease-free survival. 

10.1212/WNL.0000000000215006
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