Pathologically-proven intracranial germinoma treated with radiation therapy Hidefumi Aoyama a, *, Hiroki Shirato a , Yoshihisa Kakuto b , Hideki Inakoshi c , Masamichi Nishio d , Hiroshi Yoshida e , Masato Hareyama f , Touru Yanagisawa g , Jirou Watarai h , Kazuo Miyasaka a a Department of Radiology, Hokkaido University School of Medicine, North-15, West-7, Kita-Ku, Sapporo 060, Japan b Department of Radiology, Tohoku University School of Medicine, Sendai, Japan c Department of Radiology, Niigata University School of Medicine, Niigata, Japan d Department of Radiology, Sapporo National Cancer Center, Sapporo, Japan e Department of Radiology, Asahikawa Medical College, Asahikawa, Japan f Department of Radiology, Sapporo Medical College, Sapporo, Japan g Department of Radiology, Iwate Medical College, Iwate, Japan h Department of Radiology, Akita University School of Medicine, Akita, Japan Received 28 May 1997; revised version received 9 December 1997; accepted 6 February 1998 Abstract Background and purpose: A retrospective multi-institutional study was conducted to survey what percentage of intracranial germinomas were treated with pathological confirmation before radiotherapy and to investigate the influence of field selection on outcome. Materials and methods: Thirty-seven percent of patients (41 of 110 patients) were pathologically confirmed before radiotherapy during the past 16 years at eight institutions in Northern Japanese prefectures. Pathological confirmation was obtained in 26, 37 and 53% of cases during 1978–1983, 1984–1989 and 1990–1994, respectively. All 110 patients were examined using computed tomography (CT) scans. Among the 41 patients with pathologically confirmed germinoma, radiation fields were craniospinal in 23 patients, whole-brain in 10 patients and local without ventricle inclusion in eight patients. Results : For the 41 patients with pathologically confirmed germinoma, the actuarial and cause-specific survival rates were 91/94% at 5 years and 87/90% at 10 years, respectively. The relapse-free survival rate at 10 years was 90, 76 and 22% for the craniospinal field, whole- brain field and local field without ventricle inclusion, respectively. Conclusion: Pathological confirmation was obtained in only 37% of CT-scan era cases, although the confirmations were more commonly carried out later in the study period. Limited local irradiation alone without ventricle inclusion cannot be recommended for localized tumors even with the help of CT scanning.  1998 Elsevier Science Ireland Ltd. All rights reserved Keywords: Brain neoplasm; Children; Germinoma; Radiotherapy 1. Introduction Intracranial germinoma represents 0.5–2.5% of all intra- cranial tumors and it is more common in Japan than in Western countries [2,9,17–20,26,33]. In the past, diagnosis of the disease has generally been made radiologically due to the difficulty of biopsy, as well as the risk of tumor-seeding by biopsy [23]. More recently, however, pathological con- firmation is increasingly being used, due to advances in microsurgery and stereotaxic biopsy. Recent surveys have shown that the possibility of seeding by the surgery is not large enough, if it exists at all, to disregard pathological confirmation before radiotherapy [6,8,24]. The importance of pathological diagnosis in determining a treatment policy for pineal and suprasellar tumors has been repeatedly emphasized [8,11,14]. To our knowledge, however, there has been no reports indicating what percentage of patients have actually been treated with pathological confirmation. Germinoma is one of the most radiosensitive tumors occurring in the central nervous system (CNS) and is cur- able by radiotherapy after pathological diagnosis [28,29,35,37]. Because of the infiltrating and disseminating nature of the disease, whole-brain or craniospinal irradia- Radiotherapy and Oncology 47 (1998) 201–205 0167-8140/98/$19.00  1998 Elsevier Science Ireland Ltd. All rights reserved PII S0167-8140(98)00017-6 * Corresponding author.