[Radiation therapy and surgical management of pineal tumors--follow-up study of 96 patients (author's transl)].

This is a follow-up study of 96 patients with pineal tumors, except for one patient who was lost to follow-up. 60 of these tumors were verified histologically either at operation or at necropsy, 6 were diagnosed by epitheloid cells existing in the cerebrospinal fluid, and 30 were diagnosed by clinical and ventriculographic findings. In agreement with Russell and Rubinstein, we have classified the histologically verified tumors into 3 groups, as follows; 1. True Pinealoma Group (Pineocytoma, Pineoblastoma), 2. Germinoma-Teratoma Group, 3. Others (Glioma, Cyst). The following points need to be emphasized in the planning of management: 1. Pinealoma (Two cell pattern pinealoma) responds favorably to radiation therapy. 18 of 43 patients of pinealomas who were treated with irradiation are functioning normally in various life situations for more than 5 years. Among them, 5 cases of pinealomas treated with irradiation alone have more than 10 years survivals. 2. There is a limitation in the efficacy of irradiation therapy in cases of spinal cord implantation, infiltration in adjacent structures or subependymal infiltration along the ventricular cavity. 3. Only 2 of 67 patients with pinealomas had spinal cord metastasis. It seems undesirable to subject all patients to complete cerebrospinal axis irradiation. 4. Successful removal were performed in 4 patients with teratomas and are now alive for 9-21 years. None of them, however, are doing well clinically with many neurological deficits. 5. Since adenocarcinoma, teratocarcinoma, teratoblastoma and others are not sensitive to radiation therapy, only the palliative treatments are available. 6. Therefore, the most promising treatments for pineal tumors is that irradiation, plus shunting operation when required, is a first choice and after irradiation, radical removal should be tried in the case of teratoma diagnosed by clinical and ventriculographic findings.