TREATMENT OF INTRACRANIAL NONGERMINOMATOUS MALIGNANT GERM-CELL TUMORSPRODUCING ALPHA-FETOPROTEIN

WE TREATED 10 patients with intracranial nongerminomatous malignant ge rm cell tumors producing alpha-fetoprotein between 1969 and 1992. Two patients were treated with radiotherapy (RT) only (RT group), and thre e were treated with RT and cisplatin plus vinblastine plus bleomycin t herapy with or without surgery (cisplatin plus vinblastine plus bleomy cin group). The most recently treated five patients received cisplatin plus etoposide (PE) therapy with or without RT and/or surgery (PE gro up). The level of alpha-fetoprotein in serum was elevated in all 10 pa tients. In the PE group, PE therapy consisted of cisplatin (20 mg/m(2) ) and etoposide (60 mg/m(2)) daily for 5 days (one course) given two t o three times at 4-week intervals and then once every 4 months; the pa tients received three to six courses (mean, 4.2 courses). In the RT gr oup (n = 2), one patient died 3 months after diagnosis and the other d ied at 12 months. In the cisplatin plus vinblastine plus bleomycin gro up (n = 3), complete remission was obtained in one. patient, but the o ther two patients died 12 and 24 months after diagnosis. In contrast, in the PE group (n = 5), complete remission was obtained in all patien ts who are all currently alive without recurrence, at 35 to 71 months (average, 53.6 mo) after diagnosis. The results indicate that multidis ciplinary treatment including combination chemotherapy with cisplatin and etoposide with or without surgery and/or RT is highly effective in the treatment of patients with alpha-fetoprotein-producing intracrani al nongerminomatous malignant germ cell tumor.