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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Los tumores de c&#233;lulas germinales intracraneales &#40;TCG IC&#41; son un grupo poco frecuente y heterog&#233;neo de tumores que afectan a adolescentes y adultos j&#243;venes&#46; Su incidencia var&#237;a mucho seg&#250;n la regi&#243;n geogr&#225;fica&#44; comprendiendo el 2-4&#37; de los tumores cerebrales entre 0-19 a&#241;os en Europa<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">1&#44;2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Los TCG derivan de las c&#233;lulas germinales primordiales&#44; que en su proceso de migraci&#243;n durante la fase embrionaria desde el saco vitelino hasta el esbozo gonadal pueden anidar ect&#243;picamente en el sistema nervioso central &#40;SNC&#41; y experimentar una transformaci&#243;n neopl&#225;sica&#46; Seg&#250;n el grado de diferenciaci&#243;n que las c&#233;lulas germinales hayan alcanzado en ese momento se originan diferentes tumores&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Los TCG originados en el SNC comparten caracter&#237;sticas histol&#243;gicas&#44; gen&#233;ticas y similitudes terap&#233;uticas con los TCG extracraneales&#46; La World Health Organization &#40;WHO&#41; divide los TCG en 2 grandes grupos&#58; germinomas y TCG no germinomas &#40;TCGNG&#41;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">3&#44;4</span></a>&#44; bas&#225;ndose en la histolog&#237;a y en la presencia de marcadores tumorales &#40;<a class="elsevierStyleCrossRefs" href="#tbl0005">tablas 1 y 2</a>&#41;&#46; Otras clasificaciones dividen los TCG en tumores secretores y no secretores&#46; Los tumores secretores presentan alfafetoprote&#237;na &#40;AFP&#41; positiva o betagonadotropina cori&#243;nica humana &#40;BHCG&#41; por encima de 50 UI&#47;l en l&#237;quido cefalorraqu&#237;deo &#40;LCR&#41; o cualquier positividad de AFP o BHCG en suero<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">5&#44;6</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">La presentaci&#243;n cl&#237;nica depende de la localizaci&#243;n y el tama&#241;o del tumor&#46; La localizaci&#243;n m&#225;s frecuente es la pineal&#44; seguido de la supraselar<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">7</span></a>&#46; Los s&#237;ntomas de presentaci&#243;n m&#225;s frecuentes son anomal&#237;as endocrinas&#44; signos de hipertensi&#243;n intracraneal y alteraciones visuales&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Una correcta estadificaci&#243;n y la histolog&#237;a son factores importantes para clasificar el paciente en grupos pron&#243;sticos<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;8</span></a>&#46; Los estudios de imagen no permiten diferenciar los TCG de otros tumores&#44; por lo que es necesario confirmaci&#243;n histol&#243;gica&#44; excepto en casos en los que existe elevaci&#243;n de marcadores tumorales&#44; como AFP y BHCG<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">3</span></a>&#46; El manejo quir&#250;rgico est&#225; limitado por la localizaci&#243;n del tumor&#46; Hist&#243;ricamente&#44; el tratamiento consist&#237;a en irradiaci&#243;n craneoespinal&#46; En las 2 &#250;ltimas d&#233;cadas los avances en las t&#233;cnicas de imagen&#44; radioterapia &#40;RT&#41; y cirug&#237;a y la asociaci&#243;n de tratamiento quimioter&#225;pico han mejorado significativamente el pron&#243;stico de los TCG malignos&#44; especialmente los germinomas&#44; cuya supervivencia global a los 10 a&#241;os es &#62; 90&#37;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">3&#44;9&#44;10</span></a>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Elecci&#243;n de los pacientes</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio retrospectivo de los pacientes diagnosticados de TCG IC en el Servicio de Oncolog&#237;a del Hospital Universitario Infantil Ni&#241;o Jes&#250;s de Madrid durante los a&#241;os 1994-2014&#46; Los criterios de inclusi&#243;n fueron&#58; <span class="elsevierStyleItalic">a&#41;</span> pacientes de edad menor o igual a 18 a&#241;os&#44; y <span class="elsevierStyleItalic">b&#41;</span> diagnosticados de TCG IC seg&#250;n la clasificaci&#243;n de WHO<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">3</span></a>&#46; Se identific&#243; a 20 pacientes&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Las variables recogidas fueron edad&#44; sexo&#44; localizaci&#243;n del tumor&#44; s&#237;ntomas al diagn&#243;stico y duraci&#243;n de los mismos&#44; diseminaci&#243;n leptomen&#237;ngea&#44; histolog&#237;a&#44; marcadores tumorales en sangre y&#47;o LCR&#44; tipo de cirug&#237;a realizada y complicaciones&#44; tipo de quimioterapia &#40;QT&#41; y&#47;o RT administrada y complicaciones&#44; reca&#237;da tumoral&#44; alteraciones durante el seguimiento a largo plazo &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Diagn&#243;stico</span><p id="par0040" class="elsevierStylePara elsevierViewall">El diagn&#243;stico de TCG IC se bas&#243; en biopsia de tejido tumoral&#44; niveles de AFP y BHCG en sangre y LCR&#44; y resonancia magn&#233;tica &#40;RM&#41;&#46; Se realiz&#243; en todos los pacientes estudio de LCR y resonancia craneoespinal para valorar la existencia de diseminaci&#243;n leptomen&#237;ngea&#46; Se consider&#243; el diagn&#243;stico de TCGNG cuando se obtuvo confirmaci&#243;n histol&#243;gica y&#47;o elevaciones de AFP en sangre o LCR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>25<span class="elsevierStyleHsp" style=""></span>ng&#47;ml y&#47;o BHCG mayor de 50 UI&#47;l&#46; Se realiz&#243; evaluaci&#243;n del eje HPT-HPH al diagn&#243;stico en todos los pacientes&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Tratamiento</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Cirug&#237;a</span><p id="par0045" class="elsevierStylePara elsevierViewall">Se realiz&#243; alg&#250;n procedimiento neuroquir&#250;rgico para obtener muestra para confirmaci&#243;n histol&#243;gica en 18 pacientes&#46; Se realiz&#243; biopsia en 6 pacientes &#40;una biopsia transesfenoidal y 5 a trav&#233;s de tr&#233;pano frontal derecho guiadas con euronavegador&#41; y resecci&#243;n parcial en 12 pacientes &#40;6 craneotom&#237;as occipitales&#44; 3 craneotom&#237;as frontales y 2 pterionales&#46; En un paciente se desconoce la v&#237;a de abordaje&#41;&#46; Once pacientes presentaron hidrocefalia al diagn&#243;stico&#59; en 8 de ellos se coloc&#243; v&#225;lvula de derivaci&#243;n ventriculoperitoneal &#40;VDVP&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Quimioterapia</span><p id="par0050" class="elsevierStylePara elsevierViewall">Los pacientes recibieron varios reg&#237;menes de QT basados en cisplatino&#46; Se emplearon diferentes protocolos&#58; UK CCSG &#40;BEP&#41;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">11</span></a>&#44; Societ&#233; Francaise d¿Oncologie P&#233;diatrique &#40;SFOP&#41;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">12</span></a>&#44; Children Oncology Group &#40;COG&#41;&#44; Pediatric Blood Cancer 2007<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">13</span></a> y SIOP CNS CGT 2003&#46; Los f&#225;rmacos y las dosis administrados se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Radioterapia</span><p id="par0055" class="elsevierStylePara elsevierViewall">Recibieron RT 18 pacientes &#40;4 pacientes en el Hospital Puerta de Hierro de Madrid&#44; 11 en el Hospital Gregorio Mara&#241;&#243;n de Madrid y 3 en otros centros externos&#41;&#46; Se aplicaron diferentes modalidades de RT&#58; 2 pacientes recibieron RT holocraneal &#40;dosis 30 y 34<span class="elsevierStyleHsp" style=""></span>Gy&#41;&#44; 7 pacientes recibieron RT ventricular &#40;dosis 30-45<span class="elsevierStyleHsp" style=""></span>Gy&#41; y 5 pacientes recibieron RT craneoespinal &#40;23&#44;4-30<span class="elsevierStyleHsp" style=""></span>Gy&#41;&#46; Todos estos pacientes recibieron una sobreimpresi&#243;n sobre el lecho tumoral &#40;21-59&#44;4<span class="elsevierStyleHsp" style=""></span>Gy&#41;&#46; Tres pacientes recibieron solo irradiaci&#243;n focal sobre el volumen tumoral inicial &#40;dosis 30&#44;6-54<span class="elsevierStyleHsp" style=""></span>Gy&#41;&#46; Un paciente estaba pendiente de iniciar RT en el momento del an&#225;lisis&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">An&#225;lisis estad&#237;stico</span><p id="par0060" class="elsevierStylePara elsevierViewall">Se defini&#243; la supervivencia global como el tiempo transcurrido desde el diagn&#243;stico hasta el momento de la muerte por cualquier causa o la &#250;ltima visita de seguimiento&#46; La supervivencia global se calcul&#243; usando el m&#233;todo de Kaplan-Meier&#46; Se utiliz&#243; el test de Long-Rank para comparar la supervivencia global entre los diferentes tipos histol&#243;gicos &#40;germinoma puro comparado con TCGNG&#41;&#46; El punto de referencia para este estudio se consider&#243; la fecha de la intervenci&#243;n neuroquir&#250;rgica&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">Durante los a&#241;os 1994-2014 se diagnostic&#243; a 438 pacientes con neoplasias intracraneales malignas&#44; de los cuales 20 fueron TCG IC&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">La edad media al diagn&#243;stico fue de 11&#44;1 a&#241;os &#40;rango 2-18 a&#241;os&#41;&#46; El pico de incidencia var&#237;a seg&#250;n la histolog&#237;a&#44; observ&#225;ndose diferencias entre germinomas &#40;edad media&#58; 12&#44;21 a&#241;os&#41; y TCGNG &#40;edad media&#58; 8&#44;5 a&#241;os&#41;&#46; Se obtuvieron 14 ni&#241;os y 6 ni&#241;as&#44; observ&#225;ndose una prevalencia global mayor en el sexo masculino &#40;2&#44;3&#58;1&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Los TCG IC encontrados se clasificaron seg&#250;n la clasificaci&#243;n propuesta por la WHO<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">3</span></a>&#46; El tipo histol&#243;gico m&#225;s frecuente fue el germinoma &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Se observ&#243; elevaci&#243;n de AFP &#62; 25<span class="elsevierStyleHsp" style=""></span>ng&#47;ml en sangre o LCR en 4 casos &#40;2 tumores germinales mixtos&#44; un tumor del seno endod&#233;rmico y un TCGNG secretor no biopsiado&#41; y elevaci&#243;n de BHCG &#62; 50 UI&#47;l en 3 de 18 pacientes &#40;un tumor germinal mixto&#44; un tumor del seno endod&#233;rmico y un TCGNG secretor no biopsiado&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Se registraron 9 casos de localizaci&#243;n pineal &#40;45&#37;&#41;&#44; 9 supraselar &#40;45&#37;&#41;&#44; un caso en ganglios basales y t&#225;lamo &#40;5&#37;&#41; y un tumor multic&#233;ntrico &#40;5&#37;&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">El 77&#44;7&#37; de los tumores de localizaci&#243;n pineal fueron varones&#46; En las mujeres&#44; la localizaci&#243;n m&#225;s frecuente fue en la regi&#243;n supraselar &#40;66&#44;6&#37;&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">El tiempo medio de presentaci&#243;n de s&#237;ntomas hasta el diagn&#243;stico fue de 7&#44;6 meses &#40;rango 0&#44;1-27 meses&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Los s&#237;ntomas m&#225;s frecuentes al diagn&#243;stico en los tumores de localizaci&#243;n pineal fueron cefalea y v&#243;mitos &#40;77&#44;7&#37;&#41;&#44; seguidos de alteraciones visuales &#40;44&#44;44&#37;&#41;&#58; diplop&#237;a&#44; s&#237;ndrome de Parinaud y movimientos oculares err&#225;ticos&#46; Los s&#237;ntomas m&#225;s frecuentes en los tumores de localizaci&#243;n supraselar fueron polidipsia y poliuria &#40;100&#37;&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">El 55&#44;5&#37; de los tumores de localizaci&#243;n supraselar presentaron otras alteraciones endocrinas al diagn&#243;stico&#44; siendo las m&#225;s frecuentes hipotiroidismo &#40;55&#44;5&#37;&#41;&#44; d&#233;ficit de hormona del crecimiento &#40;11&#44;1&#37;&#41; y pubertad precoz &#40;22&#44;2&#37;&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">El tumor con localizaci&#243;n en los ganglios basales comenz&#243; con hemiparesia izquierda&#44; que fue interpretada en la resonancia inicial como infarto cerebral&#46; El paciente era portador heterocigoto de la mutaci&#243;n 20201 en el gen de la protrombina y presentaba alteraci&#243;n de la lipoprote&#237;na A&#44; siendo ambas posibles causas e infarto cerebral en ni&#241;os&#46; Se decidi&#243; tratamiento antiagregante y control evolutivo&#46; En control de RM realizado 7 meses despu&#233;s se observ&#243; aumento de la lesi&#243;n compatible con tumor neuroectod&#233;rmico&#44; por lo que fue biopsiado&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">El 44&#44;4&#37; de los pacientes con tumores de localizaci&#243;n supraselar fueron diagnosticados previamente de diabetes ins&#237;pida &#40;DI&#41; central de causa desconocida por no ser la resonancia craneal inicial concluyente con diagn&#243;stico de tumor germinal&#46; El tiempo medio en que se lleg&#243; a demostrar la existencia de un tumor germinal en resonancias posteriores fue de 21 meses &#40;rango 15-24 meses&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Se realiz&#243; confirmaci&#243;n histol&#243;gica en el 95&#37; de los pacientes&#46; El &#250;nico caso en el que no se realiz&#243; estudio histol&#243;gico fue un tumor hipofisario con AFP y BHCG elevadas&#46; En un paciente no se obtuvo confirmaci&#243;n anatomopatol&#243;gica al diagn&#243;stico pero s&#237; en la recidiva&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">El 77&#44;7&#37; de los pacientes no present&#243; ninguna complicaci&#243;n relacionada con el procedimiento quir&#250;rgico&#46; Un paciente present&#243; un hematoma epidural tras colocaci&#243;n de la VDVP que precis&#243; drenaje&#44; 2 pacientes presentaron neumoenc&#233;falo que evolucion&#243; favorablemente y un paciente present&#243; un seudomeningocele occipital que precis&#243; drenaje&#46; No se produjo ning&#250;n fallecimiento relacionado con la cirug&#237;a&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Solo uno de los pacientes mostr&#243; diseminaci&#243;n leptomen&#237;ngea con c&#233;lulas tumorales en el LCR &#40;5&#37;&#41; en el momento del diagn&#243;stico&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Al diagn&#243;stico recibieron RT el 90&#37; de los pacientes y QT asociada a RT el 55&#37;&#46; El 66&#37; de los pacientes present&#243; buena tolerancia a la RT&#46; Los efectos adversos relacionados con la RT fueron&#58; toxicidad cut&#225;nea &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; toxicidad hematol&#243;gica grado <span class="elsevierStyleSmallCaps">ii</span> &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; v&#243;mitos grado <span class="elsevierStyleSmallCaps">i</span>&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; y s&#237;ndrome post-RT con cefalea&#44; astenia y somnolencia que precis&#243; tratamiento con dexametasona &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Recibieron QT en el tratamiento inicial 12 pacientes&#46; Se administraron en total 41 ciclos de QT&#46; Las complicaciones asociadas a la QT fueron toxicidad hematol&#243;gica &#40;grados 3 y 4&#58; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; digestiva &#40;grados 3 y 4&#58; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41;&#44; neutropenia febril sin documentaci&#243;n microbiol&#243;gica &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41; y un episodio de convulsi&#243;n hiponatr&#233;mica debida a descompensaci&#243;n de la DI durante la hiperhidrataci&#243;n empleada para la administraci&#243;n de QT&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Los tratamientos administrados tras la confirmaci&#243;n histol&#243;gica pueden observarse en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Presentaron reca&#237;da tumoral 4 pacientes &#40;20&#37;&#41;&#44; de los cuales 3 fallecieron y otro contin&#250;a en remisi&#243;n completa tras trasplante aut&#243;logo&#46; En todos los casos se trat&#243; de reca&#237;da con diseminaci&#243;n leptomen&#237;ngea y todos ellos presentaron s&#237;ntomas cl&#237;nicos en el momento de la reca&#237;da &#40;anorexia&#44; dolor y dificultad para la relajaci&#243;n de extremidades inferiores&#44; hemiparesia&#44; dolor lumbar&#44; empeoramiento del habla y brasdipsiquia&#41; En uno de los 4 pacientes la reca&#237;da se produjo fuera del campo de RT&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">El tiempo medio hasta la reca&#237;da en los germinomas fue de 49 meses y en los TCGNG de 12&#44;5 meses&#46; En todos los casos de reca&#237;da se realiz&#243; trasplante aut&#243;logo tras QT de rescate&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">La supervivencia global fue del 84&#37; &#40;el 85&#44;7&#37; para germinomas y el 60&#37; para TCGNG&#41;&#44; con una mediana de seguimiento de 58 meses &#40;rango 1&#44;43-106&#46;9 meses&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">Un paciente diagnosticado de tumor de saco vitelino fue perdido a los 12 meses del diagn&#243;stico por trasladarse a otra Unidad&#46; Los datos de los pacientes fallecidos se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">Durante el seguimiento&#44; los efectos secundarios relacionados con la enfermedad y el tratamiento observados a largo plazo fueron&#58; alteraci&#243;n hormonales del eje hipot&#225;lamo-hipofisario que precisaron tratamiento hormonal sustitutivo &#40;45&#37;&#41;&#44; dificultad para la concentraci&#243;n y fallo de memoria &#40;20&#37;&#41;&#44; enfermedad renal cr&#243;nica &#40;10&#37;&#41;&#44; carcinoma papilar de tiroides &#40;5&#37;&#41; y hemianopsia bitemporal &#40;5&#37;&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discusi&#243;n</span><p id="par0175" class="elsevierStylePara elsevierViewall">Los TCG IC son poco frecuentes en ni&#241;os&#46; En nuestro caso&#44; representaron el 4&#44;5&#37; de todos los tumores malignos intracraneales diagnosticados durante los a&#241;os 1994-2004 en el Hospital Ni&#241;o Jes&#250;s&#46; Estos porcentajes son similares a los descritos en otras series en Norteam&#233;rica y Europa<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;14</span></a>&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Existe predominio en varones<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">14-16</span></a>&#44; siendo esta diferencia a&#250;n mayor en TCGNG<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">14&#44;17</span></a>&#46; Las localizaciones m&#225;s frecuentes fueron pineal y supraselar<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">7</span></a>&#46; En nuestra serie&#44; al igual que lo descrito en la literatura<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">14&#44;18</span></a>&#44; existe predilecci&#243;n por la localizaci&#243;n supraselar en mujeres&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">La localizaci&#243;n en los ganglios basales es poco frecuente&#44; representando el 4-15&#37; de los pacientes con TCG IC&#44; pero merece la pena comentarla debido a sus caracter&#237;sticas cl&#237;nicas y dificultad para el diagn&#243;stico&#46; La hemiparesia es el s&#237;ntoma m&#225;s frecuente<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">1&#44;19</span></a>&#46; En nuestra serie&#44; un caso con un tumor localizado en ganglios basales comenz&#243; con hemiparesia izquierda&#44; que fue interpretada en la resonancia inicial como infarto cerebral&#44; dadas las caracter&#237;sticas del paciente &#40;portador de mutaci&#243;n en el gen de la protrombina y alteraci&#243;n de la lipoprote&#237;na A&#41;&#46; El seguimiento con prueba de imagen llev&#243; al diagn&#243;stico del tumor&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">La sintomatolog&#237;a descrita es similar a la encontrada por otros autores&#46; Los tumores de localizaci&#243;n pineal suelen asociar s&#237;ntomas de hipertensi&#243;n intracraneal<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">7&#44;15</span></a>&#46; Anomal&#237;as oftalmol&#243;gicas han sido descritas en el 25-50&#37; de los pacientes y s&#237;ndrome de Parinaud hasta 72&#44;4&#37;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;7&#44;15</span></a>&#46; Es importante considerar la posibilidad de un tumor pineal ante sintomatolog&#237;a de hipertensi&#243;n intracraneal o s&#237;ntomas oculares&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Los tumores de localizaci&#243;n supraselar suelen presentar DI&#44; retraso del desarrollo sexual&#44; hipotiroidismo y pubertad precoz<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">15&#44;20&#44;21</span></a>&#46; Adem&#225;s&#44; pueden presentar anomal&#237;as oftalmol&#243;gicas&#46; En nuestra serie&#44; el 44&#44;4&#37; de los pacientes con TCG de localizaci&#243;n supraselar inicialmente fueron diagnosticados de DI central idiop&#225;tica por no existir evidencia de tumor en la RM inicial&#46; En estos pacientes el tiempo medio desde el inicio de la sintomatolog&#237;a con RM normal hasta la demostraci&#243;n de tumor supraselar en la RM fue de 21 meses&#59; esto ha sido descrito previamente en la literatura<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">7&#44;22&#44;23</span></a>&#46; Los s&#237;ntomas endocrinos son frecuentes en pacientes con TCG IC y pueden estar presentes mucho tiempo antes de que se pueda verificar por prueba de imagen&#46; Es importante considerar TCG cuando existan alteraciones endocrinas y realizar estudios peri&#243;dicos de imagen&#44; porque el retraso en el diagn&#243;stico aumenta el riesgo de enfermedad diseminada<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">En nuestro caso&#44; de modo similar a otros estudios<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">5</span></a>&#44; un 45&#37; de los pacientes precisaron tratamiento hormonal sustitutivo tras finalizar el tratamiento&#44; por lo que es necesario un seguimiento endocrino a largo plazo&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Los TCG pueden dividirse en 2 grandes grupos&#58; germinomas y no germinomas&#46; Los germinomas representan aproximadamente el 50-70&#37; de los casos<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;20</span></a>&#46; Esta diferenciaci&#243;n es de gran relevancia cl&#237;nica&#44; ya que el subtipo histol&#243;gico es el factor pron&#243;stico aislado m&#225;s importante en el TCG IC<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">7&#44;14&#44;16</span></a>&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Se han descrito clasificaciones terap&#233;uticas de TCG IC basadas en la clasificaci&#243;n histol&#243;gica<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">15&#44;25</span></a>&#44; que dividen los TCG IC en pron&#243;stico bueno&#44; intermedio y malo &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">tabla 7</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><p id="par0215" class="elsevierStylePara elsevierViewall">Los germinomas son tumores extremadamente quimio y radiosensibles&#46; Durante los &#250;ltimos 20 a&#241;os&#44; la irradiaci&#243;n craneoespinal ha sido el gold standard del tratamiento y ha conseguido tasas de supervivencia &#62; 90&#37; a los 5 a&#241;os<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;6&#44;10&#44;26</span></a>&#46; Sin embargo&#44; esta conlleva efectos adversos sobre el SNC&#44; la funci&#243;n tiroidea y el crecimiento<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">5&#44;27-29</span></a>&#46; En el caso de TCGNG&#44; a pesar del uso de QT intensiva y altas dosis de RT&#44; la supervivencia a los 10 a&#241;os sigue siendo del 30-80&#37;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">22&#44;23&#44;30</span></a>&#46; Actualmente se est&#225;n llevando a cabos estudios multic&#233;ntricos &#40;International Society of Pediatric Oncology CTG phase <span class="elsevierStyleSmallCaps">ii</span>&#41; con el objetivo de encontrar la m&#237;nima dosis y volumen de radiaci&#243;n posible sin afectar la supervivencia en germinomas localizados<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;14&#44;15</span></a> y en el caso de TCGNG con el objetivo de mejorar la supervivencia en pacientes de alto riesgo intensificando el tratamiento&#44; especialmente en ni&#241;os &#60; 6 a&#241;os al diagn&#243;stico y pacientes con AFP &#62; 1&#46;000<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">En nuestra serie&#44; la supervivencia para el grupo de los germinomas es menor que la descrita en la literatura&#46; Fallecieron 2&#47;14 pacientes diagnosticados de germinomas puros&#44; pero cabe destacar que estos fueron diagnosticados en los a&#241;os 1994 y 1995&#44; respectivamente&#46; Ninguno de los 12 germinomas diagnosticados durante los a&#241;os 1996-2014<span class="elsevierStyleHsp" style=""></span>ha fallecido&#46; En nuestro caso&#44; la diferencia entre la supervivencia global para germinomas y no germinomas no es estad&#237;sticamente significativa&#44; pero esto probablemente sea debido al peque&#241;o tama&#241;o de la muestra&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">En nuestra muestra&#44; se realiz&#243; confirmaci&#243;n histol&#243;gica en el 95&#37; de los pacientes&#46; El &#250;nico caso en el que no se realiz&#243; estudio histol&#243;gico fue un tumor hipofisario con AFP y BHCG elevadas&#46; Dado el diferente pron&#243;stico de este grupo de tumores&#44; establecer un diagn&#243;stico exacto con confirmaci&#243;n histol&#243;gica es fundamental para plantear un adecuado tratamiento&#46; Estudios de neuroimagen no pueden diferenciar TCG de otros tumores y&#44; por lo tanto&#44; el diagn&#243;stico requiere confirmaci&#243;n histol&#243;gica<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">7</span></a>&#44; salvo en los casos en los que existen marcadores tumorales elevados&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Hist&#243;ricamente&#44; los riesgos asociados a la cirug&#237;a llevaron al uso de m&#233;todos diagn&#243;sticos alternativos como el ensayo de irradiaci&#243;n terap&#233;utica para confirmar el diagn&#243;stico de germinoma&#46; Actualmente&#44; los avances en las t&#233;cnicas neurocirug&#237;a han hecho la cirug&#237;a de los tumores pineales mucho m&#225;s segura&#44; con una mortalidad &#60; 5&#37;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">15&#44;31</span></a>&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Dada la buena respuesta de los germinomas al tratamiento quimiorradioter&#225;pico&#44; la cirug&#237;a en este caso se encuentra limitada por la preservaci&#243;n de la funci&#243;n visual y neuroendocrina<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">5</span></a>&#46; Sin embargo&#44; una cirug&#237;a m&#225;s agresiva cobra m&#225;s importancia en TCGNG y se han descrito tasas de supervivencia mayores en pacientes en los que se ha realizado cirug&#237;a radical<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">5&#44;15&#44;32</span></a> En los casos de teratoma maduro&#44; la resecci&#243;n amplia es generalmente curativa&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">La adecuada estadificaci&#243;n es fundamental para plantear el tratamiento<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;33</span></a>&#46; No existe un sistema de estadificaci&#243;n espec&#237;fico uniformemente aceptado para germinomas y la mayor&#237;a de los investigadores utilizan sistema TNM usado para meduloblastomas<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">23</span></a>&#46; Todos los pacientes al diagn&#243;stico deber&#237;an tener RM craneoespinal&#44; AFP y BHCG en sangre y LCR&#44; punci&#243;n lumbar para estudio de citolog&#237;a de LCR&#44; evaluaci&#243;n funcional del eje hipot&#225;lamo-hipofisario&#44; exploraci&#243;n del campo visual y evaluaci&#243;n neuropsicol&#243;gica<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;5&#44;34</span></a>&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">En nuestro caso&#44; presentaron reca&#237;da 2&#47;14 pacientes diagnosticados de germinoma &#40;14&#44;2&#37;&#41;&#46; Ambos hab&#237;an recibido RT holocraneal y sobreimpresi&#243;n sobre el lecho tumoral&#46; En el caso de los TCGNG&#44; se observaron un 33&#44;3&#37; de reca&#237;das&#46; El tiempo medio hasta la reca&#237;da en los germinomas fue de 49 meses y en los TCGNG&#44; de 12&#44;5 meses&#46; En la literatura se ha descrito reca&#237;da en el 10&#37; de los germinomas<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">5&#44;35</span></a> y hasta en el 55&#44;7&#37; de TCGNG<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">15</span></a>&#46; El tiempo medio hasta la recurrencia en los germinomas oscila de 30 a 50 meses<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">1&#44;36</span></a>&#46; Recurrencias tard&#237;as despu&#233;s de 8-15 a&#241;os no son infrecuentes&#44; por lo que es necesaria la observaci&#243;n durante un per&#237;odo &#8805; 10 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">En los 4 casos de reca&#237;da descritos en nuestra serie&#44; se observ&#243; diseminaci&#243;n leptomen&#237;ngea en la reca&#237;da&#46; Seg&#250;n lo descrito en la literatura&#44; los TCG IC recaen m&#225;s frecuentemente en el tumor primario pero en el 30&#37; de los casos existe diseminaci&#243;n leptomen&#237;ngea&#46; El pron&#243;stico de los pacientes con reca&#237;da&#44; especialmente TCGNG&#44; contin&#250;a siendo pobre<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">4&#44;37</span></a>&#46; El tratamiento de rescate incluye QT&#44; RT y QT mieloablativa con trasplante aut&#243;logo<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">38&#44;39</span></a>&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusi&#243;n</span><p id="par0255" class="elsevierStylePara elsevierViewall">Los TCG IC son un grupo heterog&#233;neo de tumores&#44; que conllevan un pron&#243;stico diferente por lo que un adecuado diagn&#243;stico y estadificaci&#243;n es vital para planear el tratamiento&#46; Dado que cada vez son m&#225;s los pacientes que se curan de estos tumores&#44; deber&#237;amos identificar a pacientes de bajo riesgo en los que el tratamiento se puede minimizar para reducir el impacto en la calidad de vida de los supervivientes manteniendo la supervivencia e intensificar el tratamiento en los grupos de alto riesgo para conseguir mayor tasa de curaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">1&#44;5</span></a>&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicto de intereses</span><p id="par0260" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Los tumores de c&#233;lulas germinales intracraneales son un grupo poco frecuente de tumores en ni&#241;os&#46; Comprenden un grupo heterog&#233;neo de neoplasias&#44; que aunque comparten un origen com&#250;n&#44; presentan comportamientos cl&#237;nicos muy diferentes&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis retrospectivo de las caracter&#237;sticas epidemiol&#243;gicas e histol&#243;gicas&#44; las manifestaciones cl&#237;nicas y la evoluci&#243;n de 20 pacientes diagnosticados de tumor de c&#233;lulas germinales intracraneal en el Hospital Infantil Universitario Ni&#241;o Jes&#250;s de Madrid durante los a&#241;os 1994-2014&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se obtuvieron 20 pacientes&#58; 14 ni&#241;os y 6 ni&#241;as&#46; La edad media fue de 11&#44;1 a&#241;os &#40;rango 2-18 a&#241;os&#41;&#46; Se realiz&#243; confirmaci&#243;n histol&#243;gica en el 95&#37; de los pacientes&#46; De los 20 pacientes&#44; 14 fueron germinomas puros &#40;70&#37;&#41; y 6 tumores de c&#233;lulas germinales no germinomas &#40;30&#37;&#41;&#46; Las localizaciones m&#225;s frecuentes fueron pineal &#40;45&#37;&#41; y supraselar &#40;45&#37;&#41;&#46; Los s&#237;ntomas m&#225;s frecuentes en el momento del diagn&#243;stico en los tumores de localizaci&#243;n pineal fueron cefalea y v&#243;mitos &#40;77&#44;77&#37;&#41;&#44; seguido de alteraciones visuales &#40;44&#44;4&#37;&#41;&#44; y en los tumores de localizaci&#243;n supraselar&#44; polidipsia y poliuria &#40;100&#37;&#41;&#46; En el momento del diagn&#243;stico recibieron radioterapia el 90&#37; de los pacientes y quimioterapia asociada a la radioterapia el 55&#37;&#46; Presentaron reca&#237;da tumoral 4 pacientes &#40;20&#37;&#41;&#44; de los cuales 3 fallecieron&#46; La supervivencia global fue del 80&#37;&#44; siendo un 85&#44;7&#37; para los germinomas y un 60&#37; para los no germinomas&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El tipo histol&#243;gico m&#225;s frecuente fue el germinoma&#46; Los tumores de c&#233;lulas germinales son un grupo heterog&#233;neo de tumores que conllevan un pron&#243;stico diferente&#44; por lo que un adecuado diagn&#243;stico y estadificaci&#243;n es fundamental para planear el tratamiento&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Intracranial germ cell tumours are rare in children&#46; They are a heterogeneous group of neoplasms that show different clinical manifestations despite having a common origin&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A retrospective analysis was carried out on the epidemiological and histological characteristics&#44; clinical manifestations&#44; and outcomes of 20 patients diagnosed with intracranial germ cell tumours in the Ni&#241;o Jes&#250;s Children&#39;s Hospital of Madrid from 1994-2014&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 20 patients were identified&#58; 14 boys and 6 girls&#46; The mean age was 11&#46;1 years &#40;range 2-18 years&#41;&#46; Histological confirmation of the diagnosis was obtained in 95&#37; of the patients&#46; Of the 20 patients&#44; 14 were pure germinoma &#40;70&#37;&#41; and 6 non-seminomatous germ cell tumours &#40;30&#37;&#41;&#46; The most frequent locations were pineal &#40;45&#37;&#41; and suprasellar &#40;45&#37;&#41;&#46; The most frequent clinical symptoms in pineal tumours at diagnosis were headache and vomiting &#40;77&#46;77&#37;&#41;&#44; followed by visual disturbances &#40;44&#46;4&#37;&#41;&#46; In suprasellar tumours it was polydipsia and polyuria &#40;100&#37;&#41;&#46; At diagnosis&#44; 90&#37; of the patients received radiotherapy&#44; and 55&#37; received chemotherapy combined with radiotherapy&#46; There was a relapse in 4 patients &#40;20&#37;&#41;&#44; and 3 of them died&#46; Overall survival was 80&#37;&#59; 85&#46;7&#37; for pure germinomas and 60&#37; for non-seminomatous germ cell tumours&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The most common histological subtype was pure germinoma&#46; Germ cell tumours include heterogeneous disease entities that have a variable prognosis&#46; Thus&#44; an accurate diagnosis is vital for patient counselling and treatment planning&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introduction"
          ]
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            "identificador" => "abst0030"
            "titulo" => "Patients and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
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            "identificador" => "abst0040"
            "titulo" => "Conclusions"
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        ]
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Supervivencia global para pacientes pedi&#225;tricos diagnosticados de TCG comparando germinomas y tumores de c&#233;lulas germinales no germinomas &#40;TCGNG&#41;&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Tomado de Louis et al&#46;&#44; editores<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">3</span></a>&#46;</p>"
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Tumores de c&#233;lulas germinales</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Germinomas</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Tumores de c&#233;lulas germinales no germinomas<br><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Carcinoma embrionario<br><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Tumor del saco vitelino<br><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Coriocarcinoma<br><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Teratoma<br><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Teratoma benigno<br><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Inmaduro<br><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Maduro<br><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Teratoma con transformaci&#243;n maligna<br><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Tumores mixtos de c&#233;lulas germinales&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Clasificaci&#243;n de tumores de c&#233;lulas germinales intracraneales propuesta por la WHO</p>"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">AFP&#58; alfafetoprote&#237;na&#59; B-HCG&#58; betagonadotropina cori&#243;nica humana&#59; PLAP&#58; fosfatasa alcalina placentaria&#46;</p><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Tomado de Louis et al&#46;&#44; editores<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">3</span></a>&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Tipo de tumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Marcador</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">AFP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PLAP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">c-kit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Germinoma puro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;&#47;&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Germinoma &#40;sincitiotrofobl&#225;stico&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;&#47;&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tumor del seno endod&#233;rmico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;&#47;&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coriocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;&#47;&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Carcinoma embrionario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">TCG mixto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;&#47;&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;&#47;&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;&#47;&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;&#47;&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Teratoma maduro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Teratoma inmaduro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;&#47;-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;&#47;-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#43;&#47;&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Clasificaci&#243;n de TCG seg&#250;n los marcadores tumorales</p>"
        ]
      ]
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        "etiqueta" => "Tabla 3"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Paciente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sexo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Edad &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">A&#241;o diagn&#243;stico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagn&#243;stico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Localizaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AFP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">BHCG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diseminaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reca&#237;da&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OS &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1994&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pineal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1995&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pineal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinal mixto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Supraselar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">&#8593;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1997&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pineal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Supraselar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1998&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinal mixto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pineal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8593;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Multic&#233;ntrico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1995&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinal mixto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pineal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8593;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G&#46; basales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Supraselar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pineal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">T&#46; seno endod&#233;rmico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pineal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8593;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8593;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Supraselar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Supraselar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pineal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinal mixto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Supraselar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Supraselar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Supraselar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pineal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Germinal mixto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Supraselar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8593;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8593;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas de los pacientes con TCG intracraneales</p>"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Tomado de Einhorn y Donohue<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">11</span></a>&#44; Bouffet et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">12</span></a> y Kretschmar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">13</span></a>&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tipo tumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Tratamiento administrado</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&#46;&#176; pacientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="9" align="left" valign="top">Germinomas</td><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">Radioterapia</td><td class="td" title="table-entry  " align="left" valign="top">Holocraneal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ventricular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Craneoespinal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Desconocido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top" style="border-bottom: 2px solid black">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Quimioterapia<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>radioterapia</td><td class="td" title="table-entry  " align="left" valign="top">UK CCSG &#40;BEP&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SFOP<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">COG<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top" style="border-bottom: 2px solid black">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">TCGNG</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Quimioterapia</td><td class="td" title="table-entry  " align="left" valign="top">UK CCSG &#40;BEP&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SFOP<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SIOP CNS CGT 2003<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Children Oncology Group&#44; Pediatric Blood Cancer 2007&#58; ciclo A&#58; etop&#243;sido &#40;100 mg&#47;m<span class="elsevierStyleSup">2</span>&#47;d&#237;a&#44; d&#237;as 1-5&#41; y cisplatino &#40;20 mg&#47;m<span class="elsevierStyleSup">2</span>&#47;d&#237;a&#44; d&#237;as 1-5&#41;&#46; Ciclo B&#58; ciclofosfamida &#40;1 g&#47;m<span class="elsevierStyleSup">2</span>&#47;d&#237;a&#44; d&#237;as 1 y 2&#41; y vincristina &#40;1&#44;5 mg&#47;m<span class="elsevierStyleSup">2</span>&#47;d&#237;a&#44; d&#237;as 1&#44; 8 y 15&#41;<span class="elsevierStyleSup">13</span>&#46;</p>"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">No recibi&#243; radioterapia por presentar un Glasgow de 5 en el contexto de un hematoma subdural agudo&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tumores de c&#233;lulas germinales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&#46;&#176; pacientes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tumor del seno endod&#233;rmico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Coriocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Understanding the treatment strategies of intracranial germ cell tumors&#58; Focusing on radiotherapy"
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                            0 => "J&#46; Kim"
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                    0 => array:2 [
                      "doi" => "10.3340/jkns.2015.57.5.315"
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                        "tituloSerie" => "J Korean Neurosurg Soc&#46;"
                        "fecha" => "2015"
                        "volumen" => "57"
                        "paginaInicial" => "315"
                        "paginaFinal" => "322"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26113957"
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              "identificador" => "bib0205"
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                  "contribucion" => array:1 [
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                      "titulo" => "Epidemiological survey of central nervous system germ cell tumors in Canadian children"
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                          "autores" => array:6 [
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                            1 => "D&#46; Johnston"
                            2 => "D&#46; Strother"
                            3 => "C&#46; Fryer"
                            4 => "A&#46; Carret"
                            5 => "B&#46; Crooks"
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                    0 => array:2 [
                      "doi" => "10.1007/s11060-006-9282-2"
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                        "tituloSerie" => "J Neurooncol&#46;"
                        "fecha" => "2007"
                        "volumen" => "82"
                        "paginaInicial" => "289"
                        "paginaFinal" => "295"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17120159"
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                0 => array:1 [
                  "host" => array:1 [
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                      "LibroEditado" => array:5 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pediatric central nervous system germ cell tumors&#58; A review"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Echevarr&#237;a"
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                            2 => "S&#46; Goldman"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1634/theoncologist.2008-0037"
                      "Revista" => array:6 [
                        "tituloSerie" => "Oncologist&#46;"
                        "fecha" => "2008"
                        "volumen" => "13"
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                        "paginaFinal" => "699"
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Neurol Neurosci Rep&#46;"
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                      "doi" => "10.1055/s-2008-1071577"
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                        "tituloSerie" => "Neuropediatrics&#46;"
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                        "paginaFinal" => "32"
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                  "contribucion" => array:1 [
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