Intraventricular And Pineal Region Tumors

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The concomitant use of chemotherapy, the extent of tumor involvement and the presence of dissemination have impacted on the field of radiation therapy. For certain tumors, such as ependymoma and malignant astrocytoma, focal radiotherapy is indicated. For pineoblastomas and some germ cell tumors, craniospinal radiotherapy is more appropriate. Radiotherapy has been the primary curative treatment for germinomas arising in the pineal and suprasellar regions. Long-term control rates of 65-90% are well documented for germinomas [23,24]. The control of NGGCT and pineoblastomas with radiotherapy alone is poor, necessitating multi-modality therapy. Radiosurgery has been used in boosting the primary site of tumor or in the primary management of low-grade pineal tumors (pineocytomas) [25].

Chemotherapy is being evaluated with increasing enthusiasm for germinoma and certain NGGCT. For germinomas, attempts have been made to reduce or defer radiotherapy after a trial of adjuvant chemotherapy. Recurrence rates as high as 49% for germinomas treated with chemotherapy alone support the continued need for radiotherapy in these tumors [26]. Multimodal therapy for patients with NGGCT with radiotherapy and chemotherapy (bleomycin, vinblastine, carboplatin and etoposide) have shown a 4-year progressionfree survival of 67% [27]. Multimodality therapy is also utilized for patients with pineoblastoma, similar to medulloblastomas. In the Childrens Cancer Group protocol, there was a 3-year progression free survival rate of 61% with combined surgery, radiotherapy and chemotherapy [28]. In adults, a review of 11 patients treated at our facility with multimodality therapy showed a median survival of 30 months for patients with positive staging, with all five patients with negative staging having progression-free survival at 26 months [20].

Treatment for patients with primary glial tumors of the pineal region are similar to tumors in other locations and are not specific to this region. However, these patients need to be monitored closely for evidence of CSF dissemination.

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