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Annals of Oncology 13:1681-1685, 2002
© 2002 European Society for Medical Oncology

Clinical Investigations

Successful treatment of extracranially metastasized pineal gland germinoma with high-dose methotrexate

T. Fietz1,+, E. Thiel1, C. Baldus1, I. W. Blau1, G. Stoltenburg2 and W. U. Knauf1

1 Department of Medicine III (Hematology, Oncology and Transfusion Medicine), 2 Department of Neuropathology, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Germany

Received 15 February 2002; revised 22 April 2002; accepted 22 April 2002

Abstract

Germinoma of the pineal gland is a rare disease usually confined to the brain which responds well to radiotherapy. Spinal seeding occurs in ~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.

Key words: chemotherapy, intracranial germ-cell tumor, metastasis, methotrexate


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