In patients with intracranial germ cell tumors, residual lesions are sometimes observed after completion of primary chemoradiotherapy. Although salvage resection of these end-of-treatment residual lesions is recommended for patients with nongerminomatous germ cell tumors, the necessity of early salvage resection for those with germinoma is not clear. The aim of this study was to investigate the frequency of residual germinoma lesions after primary chemoradiotherapy, as well as their management, long-term consequences, and prognosis.

The authors retrospectively reviewed patients who were primarily treated for germinoma between 2002 and 2021. Residual lesions were evaluated with MRI with and without contrast enhancement within 2 weeks after chemoradiotherapy. The decision to perform salvage resection of residual lesions was at the discretion of the treating physicians. The change in appearance of residual lesions was assessed with serial MRI. Overall survival (OS), progression-free survival (PFS), and recurrence pattern were also investigated.

Sixty-nine patients were treated with chemoradiotherapy for germinoma, with a mean follow-up period of 108 months. Residual lesions were radiologically observed in 30 patients (43.5%). Among these, 5 patients (3 with pineal lesions and 2 with basal ganglia lesions) underwent salvage resection. Pathological examination revealed teratomatous components in 3 patients, whereas no tumoral components were identified in 2 patients. One patient with a basal ganglia lesion showed worsening of hemiparesis postoperatively. The remaining 25 patients received watchful observation without surgical intervention. Chronological periodic radiological change in residual lesions was evaluated in 21 patients. One year after primary treatment, the size of the residual lesions was stable and had decreased in 10 and 11 patients, respectively. None of the lesions increased in size. The 10-year PFS and OS rates were 96.7% and 97.3% in patients without residual lesions (n = 39), and 87.1% and 100% in patients with residual lesions (n = 30), respectively. Presence of residual lesions had no significant effect on PFS or OS. All recurrences occurred at distant sites or via dissemination without progression of the primary tumor site, regardless of the presence of residual lesion.

End-of-treatment residual lesions are not rare in patients with germinoma, and these residual lesions seldom show progression. Because of the potential risk of surgical complications, the indication for early salvage surgery for residual lesions should be carefully determined. Watchful observation is recommended for the majority of these cases.

在颅内生殖细胞肿瘤患者中，有时在完成初次放化疗后会观察到残留病灶。尽管建议对非生殖细胞瘤患者进行这些治疗结束残留病灶的挽救性切除，但对生殖细胞瘤患者进行早期挽救性切除的必要性尚不清楚。本研究的目的是调查初次放化疗后残留生殖细胞瘤病变的频率，以及它们的管理、长期后果和预后。

作者回顾性分析了 2002 年至 2021 年期间主要接受生殖细胞瘤治疗的患者。在放化疗后 2 周内用 MRI 评估残留病灶，有无对比增强。对残留病变进行抢救性切除的决定由主治医师决定。用连续 MRI 评估残留病变外观的变化。还研究了总生存期 (OS)、无进展生存期 (PFS) 和复发模式。

69 名患者接受了生殖细胞瘤的放化疗，平均随访时间为 108 个月。30 名患者（43.5%）在放射学上观察到残留病灶。其中，5例患者（3例松果体病变，2例基底节病变）接受了挽救性切除术。病理检查发现 3 例患者有畸胎瘤成分，而 2 例患者未发现肿瘤成分。一名患有基底节病变的患者术后出现偏瘫加重。其余 25 名患者在没有手术干预的情况下接受了观察观察。在 21 名患者中评估了残留病灶的时间周期周期性放射学变化。初步治疗一年后，残留病灶的大小稳定，分别有 10 名和 11 名患者缩小。没有一个病变的大小增加。没有残留病灶的患者（n = 39）和有残留病灶的患者（n = 30）的 10 年 PFS 和 OS 率分别为 96.7% 和 97.3%，分别为 87.1% 和 100%。残留病灶的存在对 PFS 或 OS 没有显着影响。所有复发都发生在远处或通过传播而原发肿瘤部位没有进展，无论是否存在残留病变。

生殖细胞瘤患者治疗结束后残留病灶并不罕见，而且这些残留病灶很少出现进展。由于存在手术并发症的潜在风险，应仔细确定残留病变早期抢救手术的指征。建议对大多数此类情况进行观察。