EXPERIENCE WITH PINEAL REGION TUMORS

The results are reported of a retrospective review of the presentation and outcome of 43 pineal region tumors treated from 1982 to 1996. inc luding 20 identified tumors: 5 germinomas, 8 teratomas, 2 embryonal ca rcinomas, 1 endodermal sinus tumor, 2 pineocytomas and 2 pineoblastoma s. Of the 43 tumors reviewed, 36 were located in the pineal region, 5 in the suprasellar, and 2 in both the pineal and suprasellar regions. Twenty patients underwent surgical resection: total in 6 and partial i n 10, while only a biopsy was taken in 4 cases. Fifteen patients were managed on the basis of serum CSF tumor markers and radiation response . Twenty-three patients with germinomas received radiotherapy (RT) and had a 5-year survival rate of 87%. Fifteen patients with non-germinom atous germ cell tumors received RT and chemotherapy following direct s urgery, and 5 died (mortality rate of 33.3%). The overall survival rat e of the 43 patients with pineal tumors was 79.1% (34/43) and the deat h rate was 20.9% (9/43). It is now recognized that the wide variety of tumor types found in the pineal region necessitates different modes o f treatment, and improved microsurgical and stereotactic surgical tech niques have made mortality and morbidity rates acceptably low. Because the radiation response and CSF cytology are not enough to determine o ptimum treatment, a tissue diagnosis should be obtained in all patient s.