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. 2019 Oct 3;14(10):e0223481.
doi: 10.1371/journal.pone.0223481. eCollection 2019.

Treatment Outcomes Based on Radiation Therapy Fields for Bifocal Germinoma: Synchronous or Disseminated Disease?

Free PMC article

Treatment Outcomes Based on Radiation Therapy Fields for Bifocal Germinoma: Synchronous or Disseminated Disease?

Seung Yeun Chung et al. PLoS One. .
Free PMC article


Intracranial germinoma sometimes present as bifocal germinoma, and whether bifocal germinoma should be treated as a synchronous or disseminated disease remains unclear. This study aimed to determine the optimal treatment modality for bifocal germinoma. Patients with bifocal germinoma who received radiotherapy (RT) from March 1990 to August 2017 were included for analysis. A total of 21 patients were included. The median follow-up period was 76.2 months (range, 6.2-305.4 months). There were 17 patients who received cranio-spinal irradiation (CSI) with local RT; 3, whole ventricular RT (WVRT) with local RT; and 1, local RT only. Three recurrences occurred (1 patient each among those who underwent CSI, WVRT, and local RT). Recurrence in the patient who received CSI and who received WVRT occurred in the right thalamus and right frontal convexity, respectively. Meanwhile, the patient who received local RT showed not only a recurred lesion in the hypothalamus, but also cerebrospinal fluid seeding. For this patient, salvage CSI was performed and complete response was achieved after treatment. However, after 9 years and 6 months, he was diagnosed with glioblastoma and expired. As for toxicity, although 17 patients showed decrease in complete blood count levels during treatment, all patients recovered soon after treatment completion. Our findings suggest that bifocal germinoma may be considered as a disseminated disease when considering the patterns of failure according to RT fields. In addition, patients who received CSI showed low acute toxicity rates. However, further studies are necessary to confirm these findings.

Conflict of interest statement

The authors have declared that no competing interests exist.


Fig 1
Fig 1. A case of bifocal germinoma at diagnosis.
(a) Suprasellar lesion (white arrow) on MRI T1 gadolinium axial image. (b) Pineal lesion (white arrow) on MRI T1 gadolinium axial image. (c) Bifocal lesions (white arrows) on MRI T1 gadolinium sagittal image. (d) Suprasellar lesion (white arrow) on MRI T1 gadolinium coronal image; E) Pineal lesion (white arrow) on MRI T1 gadolinium coronal image.
Fig 2
Fig 2. Progression-free survival according to the treatment field.
Cranio-spinal irradiation tended to show better progression-free survival, although not statistically significant (p = 0.204)).

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Grant support

This work was supported by the Ministry of Science, Korea, through the research and development program of the National Research Foundation of Korea (NRF-2017R1C1B2010379) to Hong In Yoon. The funder did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.