The prognostic significance of HCG level in CNS germinoma remains controversial, but some groups advocate more intensive treatment for germinoma with high HCG level. The purpose of this study was to compare clinical characteristics and prognosis of germinoma patients with normal or high HCG.
METHOD AND MATERIALS
We collected data on 103 patients with CNS germinoma whose HCG or beta-HCG level in the serum and/or CSF had been measured before treatment. There were 86 males and 17 females, with a median age of 19 years (range: 6-60). Predominant primary tumor site was the pineal region in 55 patients, the neurohypophyseal region in 31, the basal ganglia in 17, and the frontal lobe in two. The median longest diameter of the tumor was 3 cm (range: 0.4-7.5 cm). Pathological diagnosis was obtained in 74 patients, including the 60-year-old patient and the two patients with a frontal lobe tumor. Other 29 patients were diagnosed according to the clinical and radiological criteria. The primary target volume was the whole brain in 21 patients, the cerebrospinal axis in 26, the ventricular system in 37, and the primary tumor site in 19. The median radiation dose to the primary tumor site was 47.8 Gy (range: 16.2-60.5 Gy). Thirty-seven patients received systemic chemotherapy in combination with relatively low radiation doses (median: 46 Gy).
HCG or beta-HCG level in the serum and/or CSF was high in 43% of all patients. HCG level was significantly higher in patients with a tumor at the basal ganglia (71%) than in those with a pineal or neurohypophyseal tumor. There was no correlation between tumor size and HCG level (r=0.18). The 5- and 10-year survival rates were 96% and 94%, respectively, in both patient groups with normal and high HCG (p=0.99). The 5- and 10-year relapse-free survival rates were 88% and 84%, respectively, in both groups. (p=0.89). Also, there was no difference in prognosis between the two groups among the patients treated with radiation alone as well as those treated with radiation and chemotherapy.
Germinomas arising at the basal ganglia may more often produce HCG than those at the other sites. HCG level does not seem to influence the patient’s prognosis.