Abstract
Purpose
To perform a retrospective analysis of patients with intracranial germinoma treated in our department to evaluate treatment outcomes and determine optimal treatment strategies.
Methods
We reviewed the treatment outcomes of 170 patients with intracranial germinoma who were treated in our department from January 1996 to January 2017. The median patient age was 15 years old. Among the patients, 56 (33%) were pathologically diagnosed, and 114 (67%) were diagnosed clinically. Various radiation fields and doses were used. Cerebrospinal fluid (CSF) and serum beta-human chorionic gonadotropin (β-HCG) levels were examined before treatment in 114 patients. Endocrinological evaluation was performed in 141 patients before and after treatment. A total of 38 patients received chemotherapy prior to radiotherapy (RT). The median follow-up time was 64.5 months (range 4–260.5 months).
Results
The 5- and 10-year overall survival (OS) rates were 94.5% and 91.3%, respectively. The relapse-free survival (RFS) rates at 5- and 10-years were 91.9% and 78.1%, respectively. Relapses occurred in 18 patients within 6 months–10 years. The spinal cord metastasis rate was 3.4% in patients with a localized lesion who did not receive spinal cord irradiation and 16.7% in patients with bifocal disease who were treated using whole ventricular irradiation (WVI) or whole brain radiotherapy (WBRT). Treatment failure did not occur in patients receiving chemoradiotherapy or in patients receiving three-dimensional conformal radiation therapy (3D-CRT)/intensity-modulated radiation therapy (IMRT). The RFS rate did not have a statistically significant correlation with the CSF/serum β-HCG level. After RT, 19.1% of the patients developed newly impaired pituitary function and required hormone replacement therapy.
Conclusions
WVI or WBRT+ primary boost (PB) is a sufficient irradiation field for localized intracranial germinoma, while patients with bifocal disease should undergo craniospinal irradiation (CSI), especially when treated with RT alone. CSF β-HCG is not a prognostic marker for intracranial germinomas. The treatment results of chemotherapy followed by reduced-dose RT are comparable to those of RT alone. IMRT is recommended for intracranial germinoma to improve the target volume accuracy and decrease the complications of RT.
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References
Alapetite C, Brisse H, Patte C et al (2010) Pattern of relapse and outcome of non-metastatic germinoma patients treated with chemotherapy and limited field radiation: the SFOP experience. Neuro-oncology 12:1318–1325. https://doi.org/10.1093/neuonc/noq093
Al-Mahfoudh R, Zakaria R, Irvine E et al (2014) The management of bifocal intracranial germinoma in children Child’s nervous system. Child Nerv Syst 30:625–630. https://doi.org/10.1007/s00381-013-2287-1
Aoyama H, Shirato H, Kakuto Y et al (1998) Pathologically-proven intracranial germinoma treated with radiation therapy. Radiother Oncol 47:201–205
Calaminus G, Kortmann R, Worch J et al (2013) SIOP CNS GCT 96: final report of outcome of a prospective, multinational nonrandomized trial for children and adults with intracranial germinoma, comparing craniospinal irradiation alone with chemotherapy followed by focal primary site irradiation for patients with localized disease. Neuro-oncology 15:788–796. https://doi.org/10.1093/neuonc/not019
Chen YW, Huang PI, Ho DM et al (2012a) Change in treatment strategy for intracranial germinoma: long-term follow-up experience at a single institute. Cancer 118:2752–2762. https://doi.org/10.1002/cncr.26564
Chen YW, Huang PI, Hu YW et al (2012b) Treatment strategies for initially disseminated intracranial germinomas: experiences at a single institute. Child Nerv Syst 28:557–563. https://doi.org/10.1007/s00381-012-1683-2
Haas-Kogan DA, Missett BT, Wara WM et al (2003) Radiation therapy for intracranial germ cell tumors. Int J Radiat Oncol Biol Phys 56:511–518. https://doi.org/10.1016/s0360-3016(02)04611-4
Huang PI, Chen YW, Wong TT et al (2008) Extended focal radiotherapy of 30 Gy alone for intracranial synchronous bifocal germinoma: a single institute experience. Child Nerv Syst 24:1315–1321. https://doi.org/10.1007/s00381-008-0648-y
Joo JH, Park JH, Ra YS et al (2014) Treatment outcome of radiation therapy for intracranial germinoma: adaptive radiation field in relation to response to chemotherapy. Anticancer Res 34:5715–5721
Kanamori M, Kumabe T, Saito R et al (2009) Optimal treatment strategy for intracranial germ cell tumors: a single institution analysis. J Neurosurg Pediatrics 4:506–514. https://doi.org/10.3171/2009.7.PEDS08288
Khatua S, Dhall G, O’Neil S et al (2010) Treatment of primary CNS germinomatous germ cell tumors with chemotherapy prior to reduced dose whole ventricular and local boost irradiation. Pediatr Blood Cancer 55:42–46. https://doi.org/10.1002/pbc.22468
Lafay-Cousin L, Millar BA, Mabbott D et al (2006) Limited-field radiation for bifocal germinoma. Int J Radiat Oncol Biol Phys 65:486–492. https://doi.org/10.1016/j.ijrobp.2005.12.011
McCarthy BJ, Shibui S, Kayama T et al (2012) Primary CNS germ cell tumors in Japan and the United States: an analysis of 4 tumor registries. Neuro-oncology 14:1194–1200 https://doi.org/10.1093/neuonc/nos155
Murray MJ, Bartels U, Nishikawa R et al (2015) Consensus on the management of intracranial germ-cell tumours. Lancet Oncol 16:e470–e477. https://doi.org/10.1016/s1470-2045(15)00244-2
Nakagawa K, Aoki Y, Akanuma A et al (1992) Radiation therapy of intracranial germ cell tumors with radiosensitivity assessment. Radiat Med 10:55–61
O’Neil S, Ji L, Buranahirun C et al (2011) Neurocognitive outcomes in pediatric and adolescent patients with central nervous system germinoma treated with a strategy of chemotherapy followed by reduced-dose and volume irradiation. Pediatr Blood Cancer 57:669–673. https://doi.org/10.1002/pbc.23146
Ogawa K, Shikama N, Toita T et al (2004) Long-term results of radiotherapy for intracranial germinoma: a multi-institutional retrospective review of 126 patients. Int J Radiat Oncol Biol Phys 58:705–713. https://doi.org/10.1016/j.ijrobp.2003.07.001
Ogawa K, Yoshii Y, Shikama N et al (2008) Spinal recurrence from intracranial germinoma: risk factors and treatment outcome for spinal recurrence. Int J Radiat Oncol Biol Phys 72:1347–1354. https://doi.org/10.1016/j.ijrobp.2008.03.055
Qi XS, Stinauer M, Rogers B et al (2012) Potential for improved intelligence quotient using volumetric modulated arc therapy compared with conventional 3-dimensional conformal radiation for whole-ventricular radiation in children. Int J Radiat Oncol Biol Phys 84:1206–1211. https://doi.org/10.1016/j.ijrobp.2012.02.033
Raggi E, Mosleh-Shirazi MA, Saran FH (2008) An evaluation of conformal and intensity-modulated radiotherapy in whole ventricular radiotherapy for localised primary intracranial germinomas. Clin Oncol 20:253–260. https://doi.org/10.1016/j.clon.2007.12.011
Rogers SJ, Mosleh-Shirazi MA, Saran FH (2005) Radiotherapy of localised intracranial germinoma: time to sever historical ties? Lancet Oncol 6:509–519. https://doi.org/10.1016/s1470-2045(05)70245-x
Schoenfeld A, Haas-Kogan DA, Molinaro A et al (2014) Pure germinomas of the central nervous system: treatment strategies and outcomes. J Neuro-oncology 120:643–649. https://doi.org/10.1007/s11060-014-1599-7
Shim KW, Kim TG, Suh CO et al (2007) Treatment failure in intracranial primary germinomas. Child Nerv Syst 23:1155–1161. https://doi.org/10.1007/s00381-007-0394-6
Shim KW, Park EK, Lee YH et al (2013) Treatment strategy for intracranial primary pure germinoma. Child Nerv Syst 29:239–248. https://doi.org/10.1007/s00381-012-1902-x
Shin KH, Kim IH, Choe G (2001) Impacts of elevated level of hCG in serum on clinical course and radiotherapy results in the histology-confirmed intracranial germinomas. Acta Oncol 40:98–101
Tian C, Shi Q, Pu C et al (2011) Re-evaluation of the significance of cerebrospinal fluid human chorionic gonadotropin in detecting intracranial ectopic germinomas. J Clin Neurosci 18:223–226. https://doi.org/10.1016/j.jocn.2010.04.041
Utsuki S, Oka H, Tanaka S et al (2002) Long-term outcome of intracranial germinoma with hCG elevation in cerebrospinal fluid but not in serum. Acta Neurochir 144:1151–1154. https://doi.org/10.1007/s00701-002-1008-4 (discussion 1154–1155)
Weksberg DC, Shibamoto Y, Paulino AC (2012) Bifocal intracranial germinoma: a retrospective analysis of treatment outcomes in 20 patients and review of the literature. Int J Radiat Oncol Biol Phys 82:1341–1351. https://doi.org/10.1016/j.ijrobp.2011.04.033
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This study was approved by the institutional review board at Peking Union Medical College Hospital (PUMCH) [Protocol number S-K553].
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Informed consent was obtained from each patient or his/her guardian prior to initiating the treatment.
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Lian, X., Hou, X., Yan, J. et al. Treatment outcomes of intracranial germinoma: a retrospective analysis of 170 patients from a single institution. J Cancer Res Clin Oncol 145, 709–715 (2019). https://doi.org/10.1007/s00432-018-2743-0
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DOI: https://doi.org/10.1007/s00432-018-2743-0