Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Chemotherapy trials in recurrent primary intracranial germ cell tumors

Summary

Gonadal germ cell tumors respond favorably to chemotherapy either at diagnosis or when they recur. Histologically similar tumors may arise in the CNS usually in the pineal or suprasellar regions. Although radiation therapy may produce a 5 year disease-free survival in excess of 60% in localized pure germinoma, gern cell tumors of other histology tend to recur. We have conducted 14 chemotherapy trials in 8 patients with recurrent CNS germ cell tumors using 3 different single agent and 2 multi-agent chemotherapy regimens. The histologic diagnoses of the patients were germinoma (4), endodermal sinus tumor (2), embryonal carcinoma (1), and mixed tumor — germinoma plus choriocarcinoma (1). There were 7 males and 1 female with a median age of 13 years. The primary tumor arose in the pineal region in 6 and was multicentric in 2. Seven patients had local recurrences and one developed an initial recurrence in the spinal canal. Three patients had CNS metastases at relapse and 2 had systemic metastases. Objective responses were documented in 7 of 14 trials (50%). Responses were observed with cyclophosphamide (80 mg/kg) in 3 of 4 patients for 2+, 3, and 5 mos, cisplatin (120 mg/m2) in 1 of 2 patients for 2+ mos, and the VAB 6 protocol (vinblastine, bleomycin, cyclophosphamide, actinomycin-d, cisplatin) in 3 of 5 patients for 5, 8, and 18 mos. The median duration of response was 5 mos. (21-18). High doses of single chemotherapy agents such as cyclophosphamide and cisplatin as well the VAB6 regimen have definite activity in recurrent CNS germ cell tumors, especially germinoma. Good palliation may be achieved with chemotherapy alone with acceptable morbidity. Adjuvant chemotherapy should be considered in patients with newly diagnosed primary intracranial germ cell tumors whose tumors are considered unlikely to be permanently controlled with radiation alone.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Einhorn LH: Testicular cancer as a model for a curable neoplasm: The Richard and Hinda Rosenthal Foundation Award Lecture. Cancer Research 41: 3275–3280, 1981.

  2. 2.

    Vurgin D, Herr H, Whitmore WF et. al.: VAB-6 combination chemotherapy in disseminated testis cancer. Ann Intern Med 95: 59–61, 1981.

  3. 3.

    Pascal BR, Muss HB, Richards F et al.: Nonseminomatous germ cell cancer of the testis: reducing treatment-related morbidity in patients with disseminated disease. Cancer 50: 1742–1745, 1982.

  4. 4.

    Ball D, Barrett A, Peckham MJ: The management of metastatic seminoma of the testis. Cancer 50: 2289–2294, 1982.

  5. 5.

    Jenkin RD, Simpson WJ, Keen CW: Pineal and suprasellar germinomas: results of radiation treatment. J Neurosurg 48: 99–107, 1978.

  6. 6.

    Sano K, Matsutani M: Pinealoma (Germinoma) treated by direct surgery and postoperative irradiation. Child's brain 8: 81–97, 1981.

  7. 7.

    Wara WM, Jenkin DT, Evans A et al: Tumors of the pineal and suprasellar region: Childrens Cancer Study Group Treatment Results 1960-1975: A report from Children's Cancer Study Group. Cancer 43: 698–701, 1979.

  8. 8.

    Allen JC, Epstein F, Nisselbaum J et al: Alphafetoprotein and human chorionic gonadotropin determination in cerebralspinal fluid; an aid to the diagnosis and management of intracranial germ cell tumors. J Neurosurg 51: 368–374, 1979.

  9. 9.

    Sung D, Harisiadis L, and Chang CH: Midline pineal tumors and suprasellar germinomas: Highly curable by irradiation. Radiology 128: 745–751. 1978.

  10. 10.

    Ginsberg S, Kirshner J, Reich et al: Systemic chemotherapy for a primary germ cell tumor of the brain: A pharmacokinetic study. Cancer Treat Rep 65: 477–483, 1981.

  11. 11.

    Neuwelt EA, Glasberg M, Frenkelt et al: Malignant pineal region tumors. A clinico-pathological study. J Neurosurg 51: 597–607, 1979.

  12. 12.

    Siegel T, Pfeffer MR, Catane R et al: Successful chemotherapy of recurrent intracranial germinoma with spinal metastases. Neurology 33: 631–633, 1983.

  13. 13.

    Sklar CA, Grumbach MM, Kaplan SL et al: Hormonal and metabolic abnormalities associated with central nervous system germinoma in children and adolescents and the effects of therapy: report of 10 patients. J Clin Endocrinol Metabol 52: 9–15, 1981.

  14. 14.

    Fraley F, Lange P, Kennedy B: Germ cell testicular cancer in adults. New England J Med 301: 1370–1377, 1420–1426, 1979.

Download references

Author information

Correspondence to Jeffrey C. Allen M.D..

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Allen, J.C., Bosl, G. & Walker, R. Chemotherapy trials in recurrent primary intracranial germ cell tumors. J Neuro-Oncol 3, 147–152 (1985). https://doi.org/10.1007/BF02228891

Download citation

Key words

  • germ cell tumor
  • germinoma
  • chemotherapy