Fuller B G, Kapp D S, Cox R
Department of Radiation Oncology, Stanford University School of Medicine, CA 94305.
Int J Radiat Oncol Biol Phys. 1994 Jan 1;28(1):229-45. doi: 10.1016/0360-3016(94)90162-7.
Malignant pineal region tumors are rare neoplasms arising in midline structures of the brain. This report analyzes the influence of histology, tumor location, radiation dose, treatment volume, age and cerebrospinal fluid findings on freedom from relapse, freedom from spinal relapse and survival.
Patient and treatment parameters of 25 cases of pineal region tumors managed at Stanford University are presented, and an additional 208 published cases were reviewed. Univariate and multivariate analysis were performed to delineate parameters predictive of freedom from relapse, freedom from spinal relapse, and survival for all 233 patients.
The 5- and 10-year freedom from relapse for Stanford patients was 63% and 46%, respectively. The 5- and 10-year survival for Stanford patients was 67% and 61%, respectively. The 5- and 10-year freedom from relapse for the total 233 cases was 66% and 61%, respectively. The 5- and 10-year survival for all patients was 74% and 68%, respectively. For the entire group, biopsy confirmed germinoma and non-biopsied tumors had superior freedom from relapse compared to non-germinoma germ cell tumors (p = 0.03, p = 0.005, respectively). Non-biopsied patients had improved survival compared to non-germinoma germ cell tumors (p = 0.004). Pineal parenchymal tumors had worse freedom from relapse compared to non-biopsied patients (p = 0.04). For patients with suprasellar tumors, germinomas were associated with improved freedom from relapse compared to non-germinoma germ cell tumors (p = 0.02). Simultaneous pineal and suprasellar tumors had superior survival compared to solitary tumors of pineal (p = 0.04), suprasellar (p = 0.03), or third ventricle location (p = 0.03). Twenty-two patients (9.4%) developed isolated spinal relapse. Five- and 10-year spinal relapse rates for all patients were 11% and 13%. Survival after spinal relapse was 19%. Pineal parenchymal tumors had lower freedom from spinal relapse compared to non-biopsied patients (p = 0.001). For tumors located in the pineal gland, germinomas and pineal parenchymal tumors had lower freedom from spinal relapse than did non-biopsied patients (p = 0.006, p = 0.004, respectively). Pineal germinomas had lower freedom from spinal relapse than germinomas with suprasellar location (p = 0.04). Univariate and multivariate analysis identified tumor histology as the most significant predictor of freedom from relapse, freedom from spinal relapse and survival.
Histologic type had the greatest impact on outcome. Treatment recommendations should be based on assessment of histologic type and extent of disease.
恶性松果体区肿瘤是起源于脑中线结构的罕见肿瘤。本报告分析了组织学、肿瘤位置、放射剂量、治疗体积、年龄和脑脊液检查结果对无复发生存率、无脊髓复发生存率和总生存率的影响。
介绍了斯坦福大学治疗的25例松果体区肿瘤患者的患者及治疗参数，并回顾了另外208例已发表的病例。对所有233例患者进行单因素和多因素分析，以确定预测无复发生存率、无脊髓复发生存率和总生存率的参数。
斯坦福大学患者的5年和10年无复发生存率分别为63%和46%。斯坦福大学患者的5年和10年总生存率分别为67%和61%。233例患者的5年和10年无复发生存率分别为66%和61%。所有患者的5年和10年总生存率分别为74%和68%。对于整个队列，活检确诊的生殖细胞瘤和未活检的肿瘤与非生殖细胞性生殖细胞瘤相比，无复发生存率更高（分别为p = 0.03，p = 0.005）。未活检的患者与非生殖细胞性生殖细胞瘤相比，生存率更高（p = 0.004）。松果体实质肿瘤与未活检的患者相比，无复发生存率更低（p = 0.04）。对于鞍上肿瘤患者，生殖细胞瘤与非生殖细胞性生殖细胞瘤相比，无复发生存率更高（p = 0.02）。松果体和鞍上同时发生的肿瘤与松果体、鞍上或第三脑室单独发生的肿瘤相比，生存率更高（分别为p = 0.04，p = 0.03，p = 0.03）。22例患者（9.4%）发生孤立性脊髓复发。所有患者的5年和10年脊髓复发率分别为11%和13%。脊髓复发后的生存率为19%。松果体实质肿瘤与未活检的患者相比，无脊髓复发生存率更低（p = 0.001）。对于位于松果体的肿瘤，生殖细胞瘤和松果体实质肿瘤与未活检的患者相比，无脊髓复发生存率更低（分别为p = 0.006，p = 0.004）。松果体生殖细胞瘤与鞍上生殖细胞瘤相比，无脊髓复发生存率更低（p = 0.04）。单因素和多因素分析确定肿瘤组织学是无复发生存率、无脊髓复发生存率和总生存率的最显著预测因素。
组织学类型对预后影响最大。治疗建议应基于组织学类型和疾病范围的评估。
