Central Nervous System Germinoma Follow-up

Updated: May 04, 2015
  • Author: Amani A Al Kofide, MD; Chief Editor: Jules E Harris, MD, FACP, FRCPC  more...
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Follow-up

Further Outpatient Care

Neuropsychological assessment should be provided — especially for adolescents, to ensure proper schooling and adjustment. Patients require followup with the endocrinology, ophthalmology, neurology, and oncology team.

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Further Inpatient Care

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  • A repeat MRI of the brain should be performed within the first 48 hrs of surgery to assess for residual disease.
  • During hospitalization, daily weights and intake/output should be measured.
  • Care must be taken not to overcorrect fluid and sodium levels; repletion should be guided by fluid balance and electrolyte levels.
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Complications

Patients may have persistent neurological deficits, even after tumor control. Neurological deficits may be significant and are multifactorial in origin. Damage by the tumor itself, surgical intervention, radiation therapy and chemotherapy all contribute to neurological impairment irrespective of age. Patients with tumors located in the basal ganglia perform poorly compared with those who have tumors in the pineal and suprasellar regions; they have lower full-scale IQs and short-term retention of verbal and visual stimuli. [84]

Larger irradiation volume and dose both adversely affect intellectual functions, concept, executive function, memory, decline in neurocognitive function, and performance IQs, particularly in children. [29]

Several long-term studies have demonstrated poor performance in adaptive skills, particularly in psychosocial domains, behavioral dysfunction, and financial difficulties, leading to poor quality of life. [84, 85, 86, 87] Patients who had underwent surgical biopsies did worse than patients who had surgical resection. Lower KPS scores following surgery have been associated with impaired neurocognitive function that may decline over time, particularly in children. [85, 88]

More than 50% of patients may continue to suffer from endocrine abnormalities, with growth hormone deficiency and growth retardation, hypopituitarism, and hypothyroidism, and require lifelong hormonal replacement therapy. [85, 89]

Chemotherapy-related complications may develop; see Medication.

Pineal-region tumors have a surgical morbidity of 2-5%. Patients may suffer from transient movement abnormalities of eyes, ataxia, and cognitive dysfunction.

Brain injury in the form of atrophy, multifocal encephalomalacia, leukoencephalopathy, and focal necrosis has been reported in patients with intracranial GCTs. [30] The occurrence of cerebrovascular occlusion may lead to the development of strokes, with an almost 59-fold increase risk of death in long-term survivors. [86]

Patients with intracranial GCTs have a cumulative incidence of secondary cancer of 6%, with a cumulative risk of death due to malignancy of 16%. Radiation therapy and chemotherapy may both promote the development of secondary cancers, including but not limited to acute myeloid leukemia and radiation-induced brain neoplasms. [86]

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Prognosis

Germinomas are generally associated with an excellent prognosis. Even in those with syncytiotrophoblasts that secrete β -hCG, 5-year survival is 70-90% and 10-year survival is 70%. [1, 3]

With mixed germ cell tumors, 5-year survival is 60-80%.

With NGGCTs, 5-year survival is 30-50%.

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Patient Education

Patients and their caregivers should receive education with regard to disease, treatment options, prognosis, and expected and anticipated complications.

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