TREATMENT AND LONG-TERM OUTCOME OF PINEAL NONGERMINOMATOUS GERM-CELL TUMORS

In 1994 we reported on a small series of 3 children with malignant, ma rker-positive pineal nongerminomatous germ cell tumors treated with a 'sandwich' protocol. Here, we report on the long-term survival of thes e children. Preoperative chemotherapy consisted of two courses of bleo mycin, etoposide, and cisplatin. En bloc resection of the tumors via t he supracerebellar, infratentorial route was performed immediately aft er decline of tumor marker levels. Postoperatively, two courses of vin blastine, ifosfamide, and cisplatin were applied, followed by craniosp inal irradiation. The patients showed no major neurological deficits a nd no evidence (neuroradiologically or with regard to tumor marker lev els) of recurrence of disease after 66, 71, and 78 months, respectivel y. We propose this regimen for children with tumors of the pineal regi on in whom the tumor markers are positive. It should be started withou t histological classification of the tumor to avoid possible spillage of malignant tumor cells to the cerebrospinal fluid.