Successful treatment of extracranially metastasized pineal gland germinoma with high-dose methotrexate. |
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Authors: | T Fietz E Thiel C Baldus I W Blau G Stoltenburg W U Knauf |
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Institution: | Department of Medicine III (Hematology, Oncology and Transfusion Medicine), Universit?tsklinikum Benjamin Franklin, Freie Universit?t Berlin, Germany. toffi001@zedat.fu-berlin.de |
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Abstract: | Germinoma of the pineal gland is a rare disease usually confined to the brain which responds well to radiotherapy. Spinal seeding occurs in approximately 4% of cases and distant metastases are extremely rare. We report on a 27-year-old female with an intracranially metastasized pineal gland germinoma, meningeal carcinomatosis and distant bone metastases. Treatment was initiated with intrathecal methotrexate (MTX) and continued with high-dose intravenous MTX. The therapy was very well tolerated apart from reversible hepatic toxicity requiring a dose reduction. The patient was in complete remission after three courses followed by two consolidation cycles; the patient has now been in continuous complete remission for more than 22 months. This is the first report to show that MTX is a potent drug in treating pineal gland germinoma. Long-term side effects of radiotherapy such as reduced mental function or hypopituitarism can probably be avoided. Single-agent high-dose MTX may provide high efficacy with limited adverse effects, especially at a more advanced tumor stage with spinal seeding and extracranial disease. |
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Keywords: | chemotherapy intracranial germ-cell tumor metastasis methotrexate |
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