DOES THE RAPID RESPONSE TO CISPLATIN-BASED CHEMOTHERAPY JUSTIFY ITS USE AS PRIMARY-TREATMENT FOR INTRACRANIAL GERM-CELL TUMORS

We reviewed presentation, diagnostic problems and outcome of eight cas es of primary intracranial germ-cell tumour (4 germinoma, 4 teratoma) treated with Cisplatin-based chemotherapy at our centre over the last ten years. Three patients received primary chemotherapy with Cisplatin -based regimens followed by radiotherapy for subsequent relapse, two w ere treated with a combination of chemotherapy and external radiothera py, and three received chemotherapy for relapse after radiotherapy. Th e response to Cisplatin-based chemotherapy was rapid, with some patent s exhibiting symptomatic improvement within 24 h. Four patients achiev ed complete remission within 21 days, and three of these have remained progression-free. Four patients in total have survived for 32 to 128 + months. Six of seven patients tested pre-treatment had central diabe tes insipidus and five had partial anterior pituitary failure. The end ocrine deficit progressed in two, with no recovery in any patient. It is arguable that chemotherapy should be the primary therapy in all suc h cases diagnosed on the basis of tumour markers and imaging, with sur gery and/or radiotherapy as later options. As these tumours are rare, such questions can only be answered by collaboration studies.