Intracranial Endodermal Sinus Tumor.

Lim, Yong Chull; Cho, Kyung Gi; Lee, Seong Un; Park, Han Jun; Shin, Yong Sam; Yun, Soo Han; Cho, Ki Hong

Original Article

Journal of Korean Neurosurgical Society 2001;30(12): 1381-1387.

Yong Chull Lim, Kyung Gi Cho, Seong Un Lee, Han Jun Park, Yong Sam Shin, Soo Han Yun, Ki Hong Cho

Department of Neurosurgery, Ajou University School of Medicine, Suwon, Korea.

ABSTRACT

OBJECTIVE
Endodermal sinus tumor or yolk sac tumor is an uncommon malignant germ-cell neoplasm. This tumor was originally described as a germ cell tumor of the ovary or the testis. Intracranial endodermal sinus tumor is extremely rare and usually develop in the pineal or suprasellar regions. The authors evaluated the effect of adjuvant therapy(chemotherapy combined with radiotherapy) and radical removal of intracranial endodermal sinus tumors. MATERIAL AND METHODS: Between 1996 and 2001, four patients of intracranial endodermal sinus tumor were diagnosed with tumor marker(AFP) and biopsy. Three patients were treated with surgical removal and chemotherapy with cisplatin(20mg/m2), etoposide(100mg/m2) and bleomycin(15mg/m2) as well as external beam radiation therapy. We compared the management problems for these tumors.
RESULT
In all three patients the tumor size and the level of tumor marker decresed during initial adjuvant therapy. However, Tumors showed regrowth with elevated AFP of serum and CSF possibly related to delayed chemotherapeutic treatment or inadequate administration of chemotherapeutic drugs due to severe bone marrow suppression. An additional chemotherapy and external radiation therapy were given, but tumors could not be controlled with leptomeningeal seeding.
CONCLUSION
Radiotherapy is considered to be less effective. The combination chemotherapy with PVB(cisplatin, vinblastine, bleomycine) or PE(cisplatin, etoposide) is considered to be value in prolongation of the survival rate. But the role of chemotherapy in this tumor has not yet been clarified due to bone marrow suppression and drug resistance. Further study with large series of this tumor is necessary to establish the optimal management.

Key Words: Endodermal sinus tumor; Adjuvant therapy; Bone marrow suppression; Drug resistance