Open AccessNecessity for craniospinal irradiation of germinoma with positive cytology without spinal lesion on MR imaging—A controversy
Author(s) -
Masayuki Kanamori,
Hirokazu Takami,
Tomonari Suzuki,
Teiji Tominaga,
Jun Kurihara,
Shota Tanaka,
Seiji Hatazaki,
Motoo Nagane,
Masahide Matsuda,
Atsuo Yoshino,
Manabu Natsumeda,
Masayoshi Yamaoka,
Naoki Kagawa,
Yukinori Akiyama,
Junya Fukai,
Tetsuya Negoto,
Ichiyo Shibahara,
Kazuhiro Tanaka,
Akihiro Inoue,
Mitsuhiro Mase,
Takahiro Tomita,
Daisuke Kuga,
Noriyuki Kijima,
Tadateru Fukami,
Yukiko Nakahara,
Atsushi Natsume,
Koji Yoshimoto,
Dai Keino,
Tsutomu Tokuyama,
Kenichiro Asano,
Kenta Ujifuku,
Hiroshi Abe,
Mitsutoshi Nakada,
Keigo Matsuda,
Yoshiki Arakawa,
Naokado Ikeda,
Yoshitaka Narita,
Naoki Shinojima,
Atsushi Kambe,
Masahiko aka,
Shuichi Izumoto,
Yu Kawanishi,
Kohei Kanaya,
Sadahiro Nomura,
Kohei Nakajima,
Shohei Yamamoto,
Keita Terashima,
Koichi Ichimura,
Ryo Nishikawa
Publication year - 2021
Publication title -
neuro-oncology advances
Language(s) - English
Resource type - Journals
ISSN - 2632-2498
DOI - 10.1093/noajnl/vdab086
Subject(s) - medicine , cytology , germinoma , lesion , cerebrospinal fluid , radiology , central nervous system disease , pathology , radiation therapy
Background Cerebrospinal fluid (CSF) cytology and spinal MR imaging are routinely performed for staging before treatment of intracranial germinoma. However, the interpretation of the results of CSF cytology poses 2 unresolved clinical questions: (1) Does positive CSF cytology correlate with the presence of spinal lesion before treatment? and (2) Is craniospinal irradiation (CSI) necessary for patients with positive CSF cytology in the absence of spinal lesion? Methods Multicenter retrospective analyses were performed based on a questionnaire on clinical features, spinal MR imaging finding, results of CSF cytology, treatments, and outcomes which was sent to 86 neurosurgical and 35 pediatrics departments in Japan. Pretreatment frequencies of spinal lesion on MR imaging were compared between the patients with positive and negative cytology. Progression-free survival (PFS) rates were compared between patients with positive CSF cytology without spinal lesion on MR imaging treated with CSI and with whole brain or whole ventricular irradiation (non-CSI). Results A total of 92 germinoma patients from 45 institutes were evaluated by both CSF cytology and spinal MR images, but 26 patients were excluded because of tumor markers, the timing of CSF sampling or incomplete estimation of spinal lesion. Of the remaining 66 germinoma patients, spinal lesions were equally identified in patients with negative CSF cytology and positive cytology (4.9% and 8.0%, respectively). Eleven patients treated with non-CSI had excellent PFS comparable to 11 patients treated with CSI. Conclusion CSI is unnecessary for germinoma patients with positive CSF cytology without spinal lesions on MR imaging.