Change in treatment strategy for intracranial germinoma: Long‐term follow‐up experience at a single institute

• Published in: Cancer Vol. 118; no. 10; pp. 2752 - 2762
• Main Authors: Chen, Yi‐Wei, Huang, Pin‐I, Ho, Donald Ming‐Tak, Hu, Yu‐Wen, Chang, Kai‐Ping, Chiou, Shih‐Hwa, Guo, Wan‐Yuo, Chang, Feng‐Chi, Liang, Muh‐Lii, Lee, Yi‐Yen, Chen, Hsin‐Hung, Hsu, Ting‐Rong, Lin, Shih‐Chieh, Wong, Tai‐Tong, Yen, Sang‐Hue
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 15.05.2012; Wiley-Blackwell
• Subjects: Adolescent; Adult; Biological and medical sciences; Brain Neoplasms - mortality; Brain Neoplasms - therapy; Child; Child, Preschool; complication; Cranial Irradiation; craniospinal irradiation; Female; Follow-Up Studies; germinoma; Germinoma - mortality; Germinoma - therapy; Humans; Male; Medical sciences; Prognosis; Proportional Hazards Models; radiotherapy; Radiotherapy Dosage; Retrospective Studies; Treatment Failure; Tumors; whole ventricular irradiation; craniospinal irradiation; Cancerology; Treatment; germinoma; Follow up study; Irradiation; Complication; Intracranial germinoma; Radiotherapy; Long term; whole ventricular irradiation
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.26564

BACKGROUND: Previous intracranial germinoma (IG) studies have investigated the effect of different radiotherapy (RT) volumes and the necessity for adjunctive chemotherapy, but there is currently no consensus on the best treatment for this tumor. METHODS: From January 1989 to December 2009, 80 IG patients (≤20 years old) were treated with various RT regimens. Of them, 14 patients had craniospinal irradiation (CSI) + primary boost (PB); 8 patients had whole‐brain irradiation (WBI) + PB; 31 patients had whole ventricular irradiation (WVI) + PB; and 27 patients had focal RT only. Twenty‐nine patients (36.2%) also received systemic chemotherapy (CHT). Survival was estimated by the Kaplan‐Meier method and variables affecting survival were analyzed by the Cox proportional hazard model. RESULTS: Eleven patients (13.8%) developed local recurrence or dissemination after treatment, and 10 of these patients were in the focal RT group. The 5‐year relapse‐free survival (RFS) for the CSI, WBI, WVI, and focal RT patients were 100%, 85.7%, 100%, and 84.6%, respectively (P = .001). The 5‐year overall survival (OS) for CSI, WBI, WVI, and focal RT patients was 100%, 83.3%, 100%, and 87.9%, respectively (P = .125). Focal irradiation (P = .02) and initial use of CHT (P = .021) were negatively associated with RFS. CONCLUSIONS: Focal RT plus CHT were associated with inferior control of IG and a higher incidence of CHT‐related toxicities. Adjustment of the radiation volume to the whole ventricular system without CHT is sufficient for treatment of nondisseminated IGs, even with lower primary RT doses (<36 Gy). Cancer 2011. © 2011 American Cancer Society. Adjustment of radiation volume to whole ventricular irradiation with lower radiation dose provides long‐term control and reduced toxicity for patients with intracranial germinoma. Large‐field irradiation with chemotherapy is only suitable for patients with initial dissemination or after multisite relapse.