Patients with marker-positive central nervous system (CNS)
germ cell tumors are typically monitored for
tumor recurrence with both
tumor markers (AFP and b-hCG) and MRI. We hypothesize that the recurrence of these
tumors will always be accompanied by an elevation in
tumor markers, and that surveillance MRI may not be necessary. We retrospectively identified 28 patients with CNS
germ cell tumors treated at our institution that presented with an elevated serum or cerebrospinal fluid (CSF)
tumor marker at the time of diagnosis. We then identified those who had a
tumor recurrence after having been in remission and whether each recurrence was detected via MRI changes, elevated
tumor markers, or both. Four patients suffered a
tumor recurrence. Only one patient had simultaneously elevated
tumor markers and MRI evidence of recurrence. Two patients had evidence of recurrence on MRI without corresponding elevations in serum or CSF
tumor markers. One patient had abnormal
tumor markers with no evidence of recurrence on MRI until 6 months later. We conclude that in patients with marker-positive CNS
germ cell tumors who achieve complete remission, continued surveillance imaging in addition to measurement of
tumor markers is indicated to detect recurrences.