Journal Information
Vol. 14. Issue 2.
Pages 127-139 (January 2003)
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Vol. 14. Issue 2.
Pages 127-139 (January 2003)
Tratamiento de los tumores germinales intracraneales y otros tumores de la región pineal
Treatment of intracranial germ cell tumours and other tumours of the pineal región
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C.A. Regueiro
Servicio de Oncología Radioterápica. Hospital Universitario Clínica Puerta de Hierro. Madrid
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Resumen

El tratamiento de los pacientes con tumores germinales del sistema nervioso central está en evolución, y no se ha alcanzado un estándar definitivo.

Los datos de muchas series indican que la radioterapia exclusiva obtiene tasas de supervivencia libre de enfermedad de alrededor del 90% en los pacientes con germinomas. Varios estudios prospectivos evaluaron los resultados de tratamientos que asocian quimioterapia y radioterapia con dosis y/o volúmenes reducidos. Las tasas de supervivencia con tratamientos combinados fueron similares a las obtenidas con irradiación cráneoespinal exclusiva. Sin embargo, las tasas de recidiva fueron probablemente más altas debido al número significativo de recidivas surgidas fuera del volumen tratado con radioterapia. Son necesarios estudios adicionales para determinar los volúmenes de radioterapia adecuados y el papel de los tratamientos combinados. La quimioterapia exclusiva se asocia a cifras de recidiva muy elevadas y su uso no es recomendable.

Los teratomas maduros son tumores germinales benignos que se controlan en más del 90% de los casos con cirugía exclusiva.

Los tumores germinales no-germinomas constituyen un grupo heterogéneo de tumores que incluye tumores agresivos tales como las formas puras y mixtas de coriocarcinoma, tumor del seno endodérmico y carcinoma embrionario; y tumores con agresividad intermedia tales como los tumores mixtos con germinoma y teratoma, los teratomas inmaduros y los teratomas con transformación maligna. Tanto la radioterapia exclusiva como la quimioterapia exclusiva obtienen tasas bajas de control tumoral y los esquemas de tratamiento actuales incluyen quimioterapia y radioterapia, con resección quirúrgica del tumor en parte de los pacientes.

Los pineocitomas son tumores benignos que presen-tan cifras altas de control con extirpación quirúrgica completa o con resección parcial e irradiación local.

Los esquemas de tratamiento actual para los pine-oblastomas incluyen cirugía, quimioterapia e irradiación cráneoespinal con una sobredosificación local. La quimioterapia exclusiva se ha ensayado con muy poco éxito en estudios que pretendían demorar la irradiación en niños muy pequeños.

Palabras clave:
Tumores germinales
Germinoma
Teratoma
Pineal
Pineocitoma
Pineoblastoma
Summary

The management of patients with central nervous system germ-cell tumours is evolving, and a definitive standard has not been achieved.

A large amount of data indícate that radiotherapy alone results in long-term relapse free survival rates of about 90% in patients with germinoma. Various prospective triáis evaluated the results of combinations of chemotherapy and reduced dose and/or volume radiotherapy. The survival rates of combined treatment approaches were similar to the rates achieved with craniospinal radiotherapy alone. Nevertheless, the relapse rates were probably higher due to the significant number of relapses that arouse outside the volume trea-ted with radiotherapy. Additional studies are necessary to determine the appropriate radiotherapy volumes and the role of combined treatments. Chemotherapy alone results in high relapse rates and can not be recommen-ded.

Mature teratomas are benign germ cell tumours that can be controlled with complete surgical resection in over 90% of cases.

Non-germinoma germ cell tumours are a heteroge-neous group of tumours that includes very aggressive tumours such as mixed and puré choriocarcinomas, yolk sac tumours, and embryonal carcinomas; and tumours with intermedíate aggressiveness such as mixed tumours with germinoma and teratoma, imma-ture teratomas and teratomas with malignant trans-formation. Both radiotherapy alone and chemotherapy alone result in quite low rates of tumour control and current treatment approaches include chemotherapy and radiotherapy, with surgical removal of the tumour in some patients.

Pineocytomas are benign tumours that are contro-Ued in most cases by complete surgical resection or partial surgical resection and local ñeld irradiation.

Current treatment approaches for pineoblastomas include surgery, chemotherapy, and craniospinal irradiation with a local boost. Chemotherapy alone was used to delay irradiation in infants with very little success.

Key words:
germcell tumour
Germinoma
Teratoma
Pineal
Pineocytoma
Pineoblastoma

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