PINEAL TUMORS IN THE NORTH OF ENGLAND 1968-93

The records of 38 patients under 25 years of age presenting with pinea l tumours between 1968 and 1993, identified from the Northern Region C hildren's and Young Adults' Malignant Disease Registry, were analysed retrospectively with regards to clinical presentation, diagnostic appr oach, treatment strategy, and outcome. The overall five year survival was 45%. Fifteen patients had a histological diagnosis: six with germi nomas, three with teratomas, three with astrocytomas, and three with p inealoblastomas. One patient had a definitive diagnosis of teratoma ma de on the basis of raised tumour markers (a fetoprotein). Treatment co nsisted of surgery (87%) (ventriculoperitoneal or atrial shunt and/or biopsy), and/or radiotherapy (82%), and/or chemotherapy (26%). Those p atients with a tissue diagnosis appeared to have a more favourable out come, especially after 1976 when treatment was determined by tumour ty pe (five year survival for those with a tissue diagnosis was 91% v 51% for those without, 95% confidence intervals 74 to 100% and 26 to 75%) . This study suggests that tissue diagnosis allows more appropriate tr eatment to be delivered for children with pineal tumours resulting in improved survival. Referral to a centre with neurosurgery, radiotherap y, neuropathology, and paediatric oncology collaboration is essential.