| Gamma Knife Surgery for Pinealoma |
|
Dong Moon Jeong, Moo Seong Kim, Sang Wook Joo, Seung Jin No, Seong Hwa Paeng, Se Young Pyo, Young Gyun Jeong, Sun Il Lee, Yong Tae Jung |
|
Department of Neurosurgery, College of Medicine, Inje University, Busan Paik Hospital, Busan, Korea |
|
|
| Abstract |
Objective
Pineal region tumors represent the entire spectrum of neoplasia, with glial, meningeal, pineal parenchymal, and germ
cell with behaviors ranging from benign to highly malignant, being the cells of origin. We assessed Gamma Knife Radiosurgery
(GKS) for tumors in the Pineal region.
Methods
Between October 1994 and December 2006, 30 patients with pineal tumors were treated using GKS. Fourteen patients
(46.7%) had germinomas, 9 patients (30.0%) had low-grade astrocytomas, 3 patients (10.0%) had choriocaroinomas, 2 patients
(6.7%) had meningiomas, 1 patient (3.3%) had pineocytoma and 1 patient (3.3%) had a malignant germ cell tumor. The mean
radio-surgical tumor volume was 4.6 ml (range 0.5-36mL). The mean dose delivered to the tumor center was 25.6 Gray (Gy)
(range 20-45) and to the tumor margin, 14.6Gy (10-22.5Gy).
Results
All patients underwent serial Magnetic resonance image (MRI) scanns with a mean duration of follow-up at 37.3
months (range 10-76). Pre-GKS, 15 patients (50%) underwent shunts or external ventricular drainage(EVD) and biopsies or
tumor operations were performed in 27 patients. Imaging in 11 patients (36.7%) demonstrated partial response, 7 patients
(23.3%) displayed complete response, 6 patients (20.0%) showed stable response, and 5 patients (16.7%) displayed initial
partial response and then no response in tumor size and growth, whilst 1 patient (3.3%) displayed distinct tumor growth. Among
the patients, 14 with germinoma were treated using gamma knife surgery and booster radiotherapy, while the 5 patients were
treated with gamma knife surgery only. In 5 patients the tumors exhibited partial response, in 3 patients the tumors showed
complete response, and 5 patients showed an initial partial response and then no response after a mean of 8.3 months. Of the
5 patients with recurring germinomas, 4 patients had booster radiotherapy and (1：re-GKS), which showed partial response
using follow-up MRI imaging. The recurring germinoma cases occurred in those 4 patients who only underwent GKS, and in 1
patient treated with GKS and radiothearpy. In the 3 choriocarcinomas patients, the choriocarcinomas showed complete response
after GKS, radiotherapy and chemotherapy (2 intravenous chemotherapies and 1 intra-arterial chemotherapy). Direct surgery
was performed on one malignant germ cell tumor that showed no response.
Conclusion
GKS is safe and effective in the treatment of pineal region tumors such as meningiomas, astrocytomas and
pineocytomas. Especially in the cases of choriocarcinomas or germinomas, treatments combining radiosurgery with booster
radiotherapy exhibited better results than radio-surgery only. |
| Key Words:
Pineal region tumors, Gamma Knife radiosurgery. |
|
PDF Links
Full text via DOI
Download Citation
