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Kanamori M, Takami H, Suzuki T, et al. Necessity for craniospinal irradiation of germinoma with positive cytology without spinal lesion on MR imaging-A controversy. Neurooncol Adv. 2021;3(1):vdab086doi: 10.1093/noajnl/vdab086.
Kanamori, M., Takami, H., Suzuki, T., Tominaga, T., Kurihara, J., Tanaka, S., Hatazaki, S., Nagane, M., Matsuda, M., Yoshino, A., Natsumeda, M., Yamaoka, M., Kagawa, N., Akiyama, Y., Fukai, J., Negoto, T., Shibahara, I., Tanaka, K., Inoue, A., Mase, M., Tomita, T., Kuga, D., Kijima, N., Fukami, T., Nakahara, Y., Natsume, A., Yoshimoto, K., Keino, D., Tokuyama, T., Asano, K., Ujifuku, K., Abe, H., Nakada, M., Matsuda, K. I., Arakawa, Y., Ikeda, N., Narita, Y., Shinojima, N., Kambe, A., Nonaka, M., Izumoto, S., Kawanishi, Y., Kanaya, K., Nomura, S., Nakajima, K., Yamamoto, S., Terashima, K., Ichimura, K., & Nishikawa, R. (2021). Necessity for craniospinal irradiation of germinoma with positive cytology without spinal lesion on MR imaging-A controversy. Neuro-oncology advances, 3(1), vdab086. https://doi.org/10.1093/noajnl/vdab086
Kanamori, Masayuki, et al. "Necessity for craniospinal irradiation of germinoma with positive cytology without spinal lesion on MR imaging-A controversy." Neuro-oncology advances vol. 3,1 (2021): vdab086. doi: https://doi.org/10.1093/noajnl/vdab086
Kanamori M, Takami H, Suzuki T, Tominaga T, Kurihara J, Tanaka S, Hatazaki S, Nagane M, Matsuda M, Yoshino A, Natsumeda M, Yamaoka M, Kagawa N, Akiyama Y, Fukai J, Negoto T, Shibahara I, Tanaka K, Inoue A, Mase M, Tomita T, Kuga D, Kijima N, Fukami T, Nakahara Y, Natsume A, Yoshimoto K, Keino D, Tokuyama T, Asano K, Ujifuku K, Abe H, Nakada M, Matsuda KI, Arakawa Y, Ikeda N, Narita Y, Shinojima N, Kambe A, Nonaka M, Izumoto S, Kawanishi Y, Kanaya K, Nomura S, Nakajima K, Yamamoto S, Terashima K, Ichimura K, Nishikawa R. Necessity for craniospinal irradiation of germinoma with positive cytology without spinal lesion on MR imaging-A controversy. Neurooncol Adv. 2021 Jun 25;3(1):vdab086. doi: 10.1093/noajnl/vdab086. eCollection 2021. PMID: 34355172; PMCID: PMC8331051.
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Neurooncol Adv. 2021 Jun 25;3(1):vdab086. doi: 10.1093/noajnl/vdab086. eCollection 2021.

Necessity for craniospinal irradiation of germinoma with positive cytology without spinal lesion on MR imaging-A controversy.

Neuro-oncology advances

Masayuki Kanamori, Hirokazu Takami, Tomonari Suzuki, Teiji Tominaga, Jun Kurihara, Shota Tanaka, Seiji Hatazaki, Motoo Nagane, Masahide Matsuda, Atsuo Yoshino, Manabu Natsumeda, Masayoshi Yamaoka, Naoki Kagawa, Yukinori Akiyama, Junya Fukai, Tetsuya Negoto, Ichiyo Shibahara, Kazuhiro Tanaka, Akihiro Inoue, Mitsuhiro Mase, Takahiro Tomita, Daisuke Kuga, Noriyuki Kijima, Tadateru Fukami, Yukiko Nakahara, Atsushi Natsume, Koji Yoshimoto, Dai Keino, Tsutomu Tokuyama, Kenichiro Asano, Kenta Ujifuku, Hiroshi Abe, Mitsutoshi Nakada, Ken-Ichiro Matsuda, Yoshiki Arakawa, Naokado Ikeda, Yoshitaka Narita, Naoki Shinojima, Atsushi Kambe, Masahiko Nonaka, Shuichi Izumoto, Yu Kawanishi, Kohei Kanaya, Sadahiro Nomura, Kohei Nakajima, Shohei Yamamoto, Keita Terashima, Koichi Ichimura, Ryo Nishikawa

Affiliations

  1. Department of Neurosurgery, Tohoku University Graduate School Medicine, Sendai, Miyagi, Japan.
  2. Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
  3. Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan.
  4. Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
  5. Department of Neurosurgery, Saitama Children's Medical Center, Saitama, Saitama, Japan.
  6. Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
  7. Department of Neurosurgery, Kyorin University Faculty of Medicine, Mitaka, Tokyo, Japan.
  8. Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
  9. Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan.
  10. Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Niigata, Japan.
  11. Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan.
  12. Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
  13. Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
  14. Department of Neurological Surgery, Wakayama Medical University School of Medicine, Wakayama, Wakayama, Japan.
  15. Department of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
  16. Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
  17. Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
  18. Department of Neurosurgery, Ehime University Graduate School of Medicine, Touon, Ehime, Japan.
  19. Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
  20. Department of neurosurgery, University of Toyama, Toyama, Toyama, Japan.
  21. Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan.
  22. Department of Neurosurgery, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan.
  23. Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan.
  24. Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Saga, Japan.
  25. Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Aichi, Japan.
  26. Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima, Japan.
  27. Division of Hematology/Oncology, Kanagawa Children`s Medical Center, Yokohama, Kanagawa, Japan.
  28. Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
  29. Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan.
  30. Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Nagasaki, Japan.
  31. Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Fukuoka, Japan.
  32. Department of Neurosurgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan.
  33. Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan.
  34. Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan.
  35. Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
  36. Departments of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan.
  37. Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Kumamoto, Japan.
  38. Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan.
  39. Department of Neurosurgery, Kansai Medical University, Hirakata, Osaka, Japan.
  40. Department of Neurosurgery, Kindai University Faculty of Medicine, Higashi-Osaka, Osaka, Japan.
  41. Department of Neurosurgery, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan.
  42. Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
  43. Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
  44. Department of Neurosurgery, Tokushima University School of Medicine, Tokushima, Tokushima, Japan.
  45. Department of Pediatrics, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan.
  46. Division of Neuro-Oncology, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan.

PMID: 34355172 PMCID: PMC8331051 DOI: 10.1093/noajnl/vdab086

Abstract

BACKGROUND: Cerebrospinal fluid (CSF) cytology and spinal MR imaging are routinely performed for staging before treatment of intracranial germinoma. However, the interpretation of the results of CSF cytology poses 2 unresolved clinical questions: (1) Does positive CSF cytology correlate with the presence of spinal lesion before treatment? and (2) Is craniospinal irradiation (CSI) necessary for patients with positive CSF cytology in the absence of spinal lesion?

METHODS: Multicenter retrospective analyses were performed based on a questionnaire on clinical features, spinal MR imaging finding, results of CSF cytology, treatments, and outcomes which was sent to 86 neurosurgical and 35 pediatrics departments in Japan. Pretreatment frequencies of spinal lesion on MR imaging were compared between the patients with positive and negative cytology. Progression-free survival (PFS) rates were compared between patients with positive CSF cytology without spinal lesion on MR imaging treated with CSI and with whole brain or whole ventricular irradiation (non-CSI).

RESULTS: A total of 92 germinoma patients from 45 institutes were evaluated by both CSF cytology and spinal MR images, but 26 patients were excluded because of tumor markers, the timing of CSF sampling or incomplete estimation of spinal lesion. Of the remaining 66 germinoma patients, spinal lesions were equally identified in patients with negative CSF cytology and positive cytology (4.9% and 8.0%, respectively). Eleven patients treated with non-CSI had excellent PFS comparable to 11 patients treated with CSI.

CONCLUSION: CSI is unnecessary for germinoma patients with positive CSF cytology without spinal lesions on MR imaging.

© The Author(s) 2021. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.

Keywords: cerebrospinal fluid cytology; craniospinal irradiation; germinoma; spinal lesion

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