Pituitary germinomas: a multi-institutional study analyzing patient demographics and management patterns

• Published in: Pituitary Vol. 23; no. 4; pp. 381 - 388
• Main Authors: Bhimani, Abhiraj D., Barrington, Nikki M., Aguilar, Tania M., Arnone, Gregory D., Mehta, Ankit I.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.08.2020
• Subjects: Adolescent; Adult; African Americans; Age Distribution; Age Factors; Antineoplastic Agents - therapeutic use; Asian Americans; Biopsy; Chemoradiotherapy - methods; Child; Endocrinology; European Continental Ancestry Group; Female; Germinoma - epidemiology; Germinoma - ethnology; Germinoma - pathology; Germinoma - therapy; Human Physiology; Humans; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Neurosurgical Procedures - methods; Oceanic Ancestry Group; Pituitary Neoplasms - epidemiology; Pituitary Neoplasms - ethnology; Pituitary Neoplasms - pathology; Pituitary Neoplasms - therapy; Radiotherapy - methods; SEER Program; Sex Distribution; Survival Rate; United States - epidemiology; Young Adult; United States; Germ cell tumor; SEER; Suprasellar tumor; Pituitary germinoma; Pituitary; Suprasellar germinoma
• ISSN: 1386-341X; 1573-7403
• DOI: 10.1007/s11102-020-01042-2

Purpose Intracranial germinomas are exceedingly rare tumors found in the pineal and suprasellar regions. The extremely low incidence of pituitary germinoma has resulted in a significant gap in knowledge regarding its demographics, management, and treatment outcomes. We present the largest multicenter analysis of pituitary germinomas to date, focused on analyzing demographic and management patterns. Methods This study utilizes the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program (2004–2016) to study patients with a primary intracranial germinoma of the pituitary gland. We analyzed demographic information and management strategies among adult and pediatric populations and conducted a 20-year overall survival analysis using Kaplan-Meier curve for a descriptive evaluation of survival outcomes between age groups and treatment groups. Results 92 patients were included in the study, consisting of 58% pediatric patients and 42% adults, with overall 60% males. 82% patients received radiation as part of the treatment, with no significant difference between pediatric and adult groups. Chemotherapy was used significantly more in pediatrics (p = 0.0002) while surgery was significantly more common in adults (p = 0.0117). The most common treatment in pediatrics was radiation + chemotherapy (47%), while the most common treatment in adults was radiation + gross total resection + chemotherapy (23%) followed by radiation + gross total resection (19%). Younger age, radiotherapy, and chemotherapy were associated with increased 20-year survival on Kaplan–Meier curves. Conclusions There exist significant differences in the management of pediatric and adult populations with pituitary germinomas. The low incidence of these tumors makes them challenging to study, but also highlights the importance of national cancer registries in amassing sufficient patient data from which to draw evidence-based conclusions.