Diagnosis and treatment of pineal tumours. Kyoto University experience (1941-1984).

Our current policy for the treatment of pineal tumours is presented, based upon our experience of 139 cases of pineal tumours in a period of 44 years from 1941 through 1984. First of all, it should be emphasized that germinomas are extremely radiosensitive and are treated successfully by radiotherapy alone. Accordingly, the treatment of choice for germinomas would be radiotherapy without surgery, if the diagnosis could be made confidently by the modern armamentarium of investigations, including CT, cerebrospinal fluid cytology and serum level of tumour markers, such as alphafetoprotein and human chorionic gonadotropin. When the diagnosis of germinoma is suspected although not straightforward, CT is reexamined after a trial of diagnostic radiation of 20 Gy. If the tumour size has not been reduced at all, it is unlikely that the tumour is a germinoma and surgery should be considered for removal as well as establishment of the histological diagnosis.