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

Background This Phase II study was designed to determine response to chemotherapy and survival after response‐based radiation (RT) in children with CNS germ cell tumors. Procedure Children with germinomas and normal markers received cisplatin 100 mg/m2 + etoposide, alternating with vincristine + cyc...

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Published inPediatric Blood & Cancer Vol. 48; no. 3; pp. 285 - 291
Main Authors Kretschmar, C., Kleinberg, L., Greenberg, M., Burger, P., Holmes, Emi, Wharam, M.
Format Journal Article
LanguageEnglish
Published Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.03.2007
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Summary:Background This Phase II study was designed to determine response to chemotherapy and survival after response‐based radiation (RT) in children with CNS germ cell tumors. Procedure Children with germinomas and normal markers received cisplatin 100 mg/m2 + etoposide, alternating with vincristine + cyclophosphamide (CPM) 2 g/m2/d, for four cycles. Children with nongerminomatous tumors or with abnormal markers received doubled doses of cisplatin and CPM. For germinoma patients in complete response (CR), RT was decreased from 50.4 to 30.6 Gy. High‐risk patients received neuraxis RT: 50.4 Gy local + 30.6 Gy neuraxis in CR; 54 Gy local + 36 Gy if less than CR. Results Of 12 germinoma patients, 4 had cerebrospinal fluid (CSF) human chorionic gonadotropin (HCG) 6.9–21 mIU/ml. Of 14 nongerminomatous patients, HCG in serum or CSF was >50 mIU/ml in 9, α‐fetoprotein (AFP) abnormal in 9. Four germinoma patients attained CR, six PR, one SD, one not evaluable after resection. Two nongerminomatous patients had CR, three PR, three SD, one PD, four not evaluable after resection; one inadequately treated patient had progressive disease (PD). Both PD patients died; one SD patient died during a seizure. Eleven germinoma patients are PF at median 66 months; one patient in CR refused RT, had PD at 10 months, received RT, and was PF at 56 months. Eleven of 14 nongerminomatous patients were PF at median 58 months. Conclusion Response (germinoma, 91%; nongerminomatous, 55%) and survival are encouraging after this regimen plus response‐based RT. Pediatr Blood Cancer 2007;48:285–291. © 2006 Wiley‐Liss, Inc.
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ISSN:1545-5009
1545-5017
1096-911X
DOI:10.1002/pbc.20815