Abstract
Purpose
To evaluate the efficacy of sequential chemoradiotherapy (CRT) for intracranial germinoma by long-term follow-up.
Materials and methods
We retrospectively evaluated 23 consecutive intracranial germinoma patients without spinal dissemination, who had been treated by sequential CRT. All patients except for one were biopsied or surgically resected before treatment and all patients received both cranial and spinal magnetic resonance imaging. Three cycles of induction chemotherapy composed of etoposide and platinum agents were administered. The prescription of radiotherapy was 24 Gy per 12 fractions. No patients received spinal irradiation.
Results
All patients accomplished CRT and achieved complete remission. No severe acute and late toxicities were observed. Median follow-up time was 11.8 years. The 5- and 10-year overall survival rates were 100 and 100 %, and relapse-free survival rates were 96 and 89 %, respectively. Three patients developed intracranial recurrence and all of them were successfully salvaged by additional CRT. All patients were alive without disease at final follow-up.
Conclusion
Treatment of 24 Gy of sequential CRT for intracranial germinoma might be promising as an alternative to radiotherapy alone. Spinal irradiation may not be necessary for patients who had no spinal dissemination and who were treated with CRT.
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References
Shirato H, Nishio M, Sawamura Y, Myohjin M, Kitahara T, Nishioka T, et al. Analysis of long-term treatment of intracranial germinoma. Int J Radiat Oncol Biol Phys. 1997;37:511–5.
Shibamoto Y, Sasai K, Oya N, Hiraoka M. Intracranial germinoma: radiation therapy with tumor volume-based dose selection. Radiology. 2001;218:452–6.
Shibamoto Y, Takahashi M, Sasai K. Prognosis of intracranial germinoma with syncytiotrophoblastic giant cells treated by radiation therapy. Int J Radiat Oncol Biol Phys. 1997;37:505–10.
Baranzelli MC, Patte C, Bouffet E, Portas M, Mechinaud-Lacroix F, Sariban E, et al. An attempt to treat pediatric intracranial alphaFP and betaHCG secreting germ cell tumors with chemotherapy alone. SFOP experience with 18 cases. Societe Francaise d’Oncologie Pediatrique. J Neurooncol 1998;37:229–239.
Shibamoto Y, Sasai K, Kokubo M, Hiraoka M. Salvage radiation therapy for intracranial germinoma recurring after primary chemotherapy. J Neurooncol. 1999;44:181–5.
Sawamura Y, Shirato H, Ikeda J, Tada M, Ishii N, Kato T, et al. Induction chemotherapy followed by reduced-volume radiation therapy for newly diagnosed central nervous system germinoma. J Neurosurg. 1998;88:66–72.
Sugiyama K, Yamasaki F, Kurisu K, Kenjo M, et al. Quality of life of extremely long-time germinoma survivors mainly treated with radiotherapy. Prog Neurol Surg. 2009;23:130–9.
Aoyama H, Shirato H, Ikeda J, Fujieda K, Miyasaka K, Sawamura Y. Induction chemotherapy followed by low-dose involved-field radiotherapy for intracranial germ cell tumors. J Clin Oncol. 2002;20:857–65.
Douglas JG, Rockhill JK, Olson JM, Ellenbogen RG, Geyer JR. Cisplatin-based chemotherapy followed by focal, reduced-dose irradiation for pediatric primary central nervous system germinomas. J Pediatr Hematol Oncol. 2006;28:36–9.
Schoenfeld GO, Amdur RJ, Schmalfuss IM, Morris CG, Keole SR, Mendenhall WM, et al. Low-dose prophylactic craniospinal radiotherapy for intracranial germinoma. Int J Radiat Oncol Biol Phys. 2006;65:481–5.
Geyer JR, Cho J, Choi JU, Kim DS, Suh CO. Low-dose craniospinal irradiation as a definitive treatment for intracranial germinoma. Radiother Oncol. 2009;91:75–9.
Kretschmar C, Kleinberg L, Greenberg M, Burger P, Holmes E, Wharam M. Pre-radiation chemotherapy with response-based radiation therapy in children with central nervous system germ cell tumors: a report from the Children’s Oncology Group. Pediatr Blood Cancer. 2007;48:285–91.
Eom KY, Kim IH, Park CI, Kim HJ, Kim JH, Kim K, et al. Upfront chemotherapy and involved-field radiotherapy results in more relapses than extended radiotherapy for intracranial germinomas: modification in radiotherapy volume might be needed. Int J Radiat Oncol Biol Phys. 2008;71:667–71.
Kawabata Y, Takahashi JA, Arakawa Y, Shirahata M, Hashimoto N. Long term outcomes in patients with intracranial germinomas: a single institution experience of irradiation with or without chemotherapy. J Neurooncol. 2008;88:161–7.
Jensen AW, Issa Laack NN, Buckner JC, Schomberg PJ, Wetmore CJ, Brown PD. Long-term follow-up of dose-adapted and reduced-field radiotherapy with or without chemotherapy for central nervous system germinoma. Int J Radiat Oncol Biol Phys. 2010;77:1449–56.
Shikama N, Ogawa K, Tanaka S, Toita T, Nakamura K, Uno T, et al. Lack of benefit of spinal irradiation in the primary treatment of intracranial germinoma: a multiinstitutional, retrospective review of 180 patients. Cancer. 2005;104:126–34.
Shirato H, Aoyama H, Ikeda J, Fujieda K, Kato N, Ishi N, et al. Impact of margin for target volume in low-dose involved field radiotherapy after induction chemotherapy for intracranial germinoma. Int J Radiat Oncol Biol Phys. 2004;60:214–7.
Ogawa K, Yoshii Y, Shikama N, Nakamura K, Uno T, Onishi H, et al. Spinal recurrence from intracranial germinoma: risk factors and treatment outcome for spinal recurrence. Int J Radiat Oncol Biol Phys. 2008;72:1347–54.
Blews DE, Wang H, Kumar AJ, Robb PA, Phillips PC, Bryan RN. Intradural spinal metastases in pediatric patients with primary intracranial neoplasms: Gd-DTPA enhanced MR vs CT myelography. J Comput Assist Tomogr. 1990;14:730–5.
Darzy KH, Shalet SM. Hypopituitarism following radiotherapy revisited. Endocr Dev. 2009;15:1–24.
Laughton SJ, Merchant TE, Sklar CA, Kun LE, Fouladi M, Broniscer A. Endocrine outcomes for children with embryonal brain tumors after risk-adapted craniospinal and conformal primary-site irradiation and high-dose chemotherapy with stem-cell rescue on the SJMB-96 trial. J Clin Oncol. 2008;26:1112–8.
Rohrer TR, Beck JD, Grabenbauer GG, Fahlbusch R, Buchfelder M, Dörr HG. Late endocrine sequelae after radiotherapy of pediatric brain tumors are independent of tumor location. J Endocrinol Invest. 2009;32:294–7.
Ogawa K, Shikama N, Toita T, Nakamura K, Uno T, Onishi H, et al. Long-term results of radiotherapy for intracranial germinoma: a multi-institutional retrospective review of 126 patients. Int J Radiat Oncol Biol Phys. 2004;58:705–13.
Merchant TE, Williams T, Smith JM, Rose SR, Danish RK, Burghen GA, et al. Preirradiation endocrinopathies in pediatric brain tumor patients determined by dynamic tests of endocrine function. Int J Radiat Oncol Biol Phys. 2002;54:45–50.
Mulhern RK, Palmer SL, Reddick WE, Glass JO, Kun LE, Taylor J, et al. Risks of young age for selected neurocognitive deficits in medulloblastoma are associated with white matter loss. J Clin Oncol. 2001;19:472–9.
Palmer SL, Goloubeva O, Reddick WE, Glass JO, Gajjar A, Kun L, et al. Patterns of intellectual development among survivors of pediatric medulloblastoma: a longitudinal analysis. J Clin Oncol. 2001;19:2302–8.
Grill J, Renaux VK, Bulteau C, Viguier D, Levy-Piebois C, Sainte-Rose C, et al. Long-term intellectual outcome in children with posterior fossa tumors according to radiation doses and volumes. Int J Radiat Oncol Biol Phys. 1999;45:137–45.
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Kenjo, M., Yamasaki, F., Takayasu, T. et al. Results of sequential chemoradiotherapy for intracranial germinoma. Jpn J Radiol 33, 336–343 (2015). https://doi.org/10.1007/s11604-015-0424-3
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DOI: https://doi.org/10.1007/s11604-015-0424-3