J Korean Neurosurg Soc.  2015 Oct;58(4):334-340. 10.3340/jkns.2015.58.4.334.

Upfront Stereotactic Radiosurgery for Pineal Parenchymal Tumors in Adults

• Park JH
• Kim JH
• Kwon DH
• Kim CJ
• Khang SK
• Cho YH

• KMID: 2114369
• DOI: http://doi.org/10.3340/jkns.2015.58.4.334

Abstract

OBJECTIVE
Pineal parenchymal tumors (PPTs) in adults are rare, and knowledge regarding their optimal management and treatment outcome is limited. Herein, we present the clinical results of our series of PPTs other than pineoblastomas managed by stereotactic radiosurgery (SRS) at upfront setting.
METHODS
Between 1997 and 2014, nine consecutive adult patients with the diagnosis of PPTs, either pineocytoma or pineal parenchymal tumor of intermediate differentiation, were treated with SRS. There were 6 men and 3 women. The median age was 39 years (range, 31-53 years). All of the patients presented with symptoms of hydrocephalus. Endoscopic third ventriculostomy and biopsy was done for initial management. After histologic diagnosis, patients were treated with Gamma Knife with the mean dose of 13.3 Gy (n=3) or fractionated Cyberknife with 32 Gy (n=6).
RESULTS
After a mean follow-up of 78.6 months (range, 14-223 months), all patients were alive and all of their tumors were locally controlled except for one instance of cerebrospinal fluid seeding metastasis. On magnetic resonance images, tumor size decreased in all patients, resulting in complete response in 3 patients and partial response in 6. One patient had experienced temporary memory impairment after SRS, which improved spontaneously.
CONCLUSION
SRS is effective and safe for PPTs in adults and can be considered as a useful alternative to surgical resection at upfront setting.

Keyword

Pineal parenchymal tumor; Pineocytoma; Pineal parenchymal tumors of intermediate differentiation; Stereotactic radiosurgery

MeSH Terms

Adult*
Biopsy
Cerebrospinal Fluid
Diagnosis
Female
Follow-Up Studies
Humans
Hydrocephalus
Male
Memory
Neoplasm Metastasis
Pinealoma*
Radiosurgery*
Treatment Outcome
Ventriculostomy

Figure

• 

  Fig. 1 A 34-year-old woman with pineal parenchymal tumor of intermediate differentiation (Case No. 7). A : Gadolinium-enhanced magnetic resonance images showing a 3.2×2.4×2.0 cm sized tumor in the pineal region with obstructive hydrocephalus. B : Tumor shows diffusely high cellularity and tumor cell nuclei are pleomorphic. C : Multinucleated giant tumor cells are frequently seen (arrows). D : Tumor cells are diffusely immunoreactive for synaptophysin. E : Proliferation activity assessed by MIB-1 is low. F : She received 5-fraction Cyberknife (CK) treatment with marginal dose of 30 Gy. G : Tumor disappeared completely in 9 months after CK, and no evidence of disease was seen at the last follow-up of 3 years.

• 

  Fig. 2 A 44-year-old man with pineocytoma (Case No. 2). A : Gadolinium-enhanced magnetic resonance images at the time of Gamma Knife (GK) treatment. B : Tumor consists of relatively small, uniform, mature cells resembling normal pineocytes, and cell-free spaces filled with cell processes are forming vague rosettes. C : After GK treatment with marginal dose of 12 Gy, he achieved durable tumor response with more than 18 years of follow-up.

• 

  Fig. 3 A 31-year-old man with pineal parenchymal tumor of intermediate differentiation (Case No. 1). Gadolinium-enhanced magnetic resonance images before (A) and 84 months after Gamma Knife treatment (B). Although the primary site remained free of disease at this time, cerebrospinal fluid seeding metastases were observed in the ventricles and the cauda equina (C, arrows). He received additional craniospinal irradiation and his disease was stable at 17 years.

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