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Pure germinomas of the central nervous system: treatment strategies and outcomes

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Abstract

To evaluate the role of chemotherapy and radiation therapy in the treatment of pure germinomas of the central nervous system (CNS). We reviewed a historical cohort of 79 patients between the ages of 3–35 years who received definitive treatment for newly diagnosed, pure CNS germinoma between 1985 and 2010 at the University of California, San Francisco (UCSF). Median age at diagnosis was 15 years (interquartile range, IQR 12–20 years) and 61 (77.2 %) patients were male. Median follow-up for the cohort was 111.1 months (IQR 45.7–185.1 months). Five-year PFS rate was 86.4 % (95 % CI 76.1–92.4) and 5 year OS rate was 93.0 % (95 % CI 84.1–97.1). Median PFS was 104.6 months (IQR 41.4–170.1 months). Fourteen patients progressed and 8 died of their disease. Patients who received focal irradiation (XRT) and chemotherapy had a significantly higher rate of progression compared to those who received whole brain irradiation (WBI) or whole ventricle irradiation (WVI). Three of 8 patients had a PR to chemotherapy and received focal XRT progressed whereas only 1 of 9 patients who had a CR to chemotherapy who went on to receive focal XRT progressed. Elevation of hCGβ > 50 mIU/ml was not significantly associated with disease progression (HR 5.64, 95 % CI 0.97–32.7, p = 0.054). Patients treated with WBI or WVI with or without chemotherapy achieve better disease control compared to patients treated with focal XRT + chemotherapy.

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Acknowledgments

The work was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant number KL2TR000143 (SM).

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Authors and Affiliations

  1. School of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA

    Adam Schoenfeld

  2. Department of Neurosurgery, University of California San Francisco (UCSF), San Francisco, CA, USA

    Daphne A. Haas-Kogan, Annette Molinaro, Theodore Nicolaides, Nalin Gupta & Sabine Mueller

  3. Department of Radiation Oncology, University of California San Francisco (UCSF), San Francisco, CA, USA

    Daphne A. Haas-Kogan

  4. Department of Epidemiology and Biostatistics, University of California San Francisco (UCSF), San Francisco, CA, USA

    Annette Molinaro

  5. Department of Pediatrics, University of California San Francisco (UCSF), San Francisco, CA, USA

    Anu Banerjee, Theodore Nicolaides, Nalin Gupta & Sabine Mueller

  6. Department of Pathology, University of California San Francisco (UCSF), San Francisco, CA, USA

    Tarik Tihan & Andrew W. Bollen

  7. Department of Neurology, Sandler Neuroscience Center, University of California San Francisco (UCSF), Mission Bay Campus, 625 Nelson Ring, Room 402C, San Francisco, CA, 94149, USA

    Sabine Mueller

Authors
  1. Adam Schoenfeld
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  2. Daphne A. Haas-Kogan
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  3. Annette Molinaro
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  4. Anu Banerjee
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  5. Theodore Nicolaides
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  6. Tarik Tihan
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  7. Andrew W. Bollen
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  8. Nalin Gupta
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  9. Sabine Mueller
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Correspondence to Sabine Mueller.

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Schoenfeld, A., Haas-Kogan, D.A., Molinaro, A. et al. Pure germinomas of the central nervous system: treatment strategies and outcomes. J Neurooncol 120, 643–649 (2014). https://doi.org/10.1007/s11060-014-1599-7

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  • DOI: https://doi.org/10.1007/s11060-014-1599-7

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