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Cappellano AM, Dassi N, Mançano B, Epelman S, Almeida DB, Cavalheiro S, Dastoli PA, Seixas MT, Nicacio JM, Costa MD, Silva FA, Aguiar SS, Almeida CR, Teixeira GR, Chen M, Figueiredo ML, Silva NS, Finlay JL. Outcome of Children and Adolescents With Primary Intracranial Germinoma Treated With Chemotherapy and Reduced Dose-Field Irradiation: A Prospective Brazilian Experience. JCO Glob Oncol 2023; 9:e2200257. [PMID: 37075267 PMCID: PMC10497279 DOI: 10.1200/go.22.00257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/20/2023] [Accepted: 02/24/2023] [Indexed: 04/21/2023] Open
Abstract
PURPOSE This prospective Brazilian single-arm trial was conducted to determine response to chemotherapy and survival after response-based radiotherapy in children with intracranial germinomas, in the setting of a multi-institutional study in a middle-income country (MIC) with significant disparity of subspecialty care. PATIENTS AND METHODS Since 2013, 58 patients with histologic and/or serum and CSF tumor marker evaluations of primary intracranial germ cell tumors were diagnosed; 43 were germinoma with HCGβ levels ≤200 mIU/mL and five between 100 and 200 mIU/mL. The treatment plan consisted of four cycles of carboplatin and etoposide followed by 18 Gy whole-ventricular field irradiation (WVFI) and primary site(s) boost up to 30 Gy; 24 Gy craniospinal was prescribed for disseminated disease. RESULTS Mean age 13.2 years (range, 4.7-25.5 years); 29 were males. Diagnosis was made by tumor markers (n = 6), surgery (n = 25), or both (n = 10). Two bifocal cases with negative tumor markers were treated as germinoma. Primary tumor location was pineal (n = 18), suprasellar (n = 14), bifocal (n = 10), and basal ganglia/thalamus (n = 1). Fourteen had ventricular/spinal spread documented by imaging studies. Second-look surgery occurred in three patients after chemotherapy. Thirty-five patients achieved complete responses after chemotherapy, and eight showed residual teratoma/scar. Toxicity was mostly grade 3/4 neutropenia/thrombocytopenia during chemotherapy. At a median follow-up of 44.5 months, overall and event-free survivals were 100%. CONCLUSION The treatment is tolerable, and WVFI dose reduction to 18 Gy preserves efficacy; we have demonstrated the feasibility of successfully conducting a prospective multicenter trial in a large MIC despite resource disparity.
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Affiliation(s)
| | - Natalia Dassi
- Pediatric Oncology, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Bruna Mançano
- Pediatric Oncology, Hospital do Amor, Barretos, Brazil
| | - Sidnei Epelman
- Pediatric Oncology, Hospital Santa Marcelina, TUCCA, São Paulo, Brazil
| | - Daniela B. Almeida
- Nursing Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Sergio Cavalheiro
- Neurosurgery Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Patricia A. Dastoli
- Neurosurgery Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Maria Teresa Seixas
- Pathology Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Jardel M. Nicacio
- Neurosurgery Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Marcos D. Costa
- Neurosurgery Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Frederico A. Silva
- Radiology Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Simone S. Aguiar
- Pediatric Oncology, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Michael Chen
- Radiotherapy Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | | | - Nasjla S. Silva
- Pediatric Oncology, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
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Yeo KK, Nagabushan S, Dhall G, Abdelbaki MS. Primary central nervous system germ cell tumors in children and young adults: A review of controversies in diagnostic and treatment approach. Neoplasia 2022; 36:100860. [PMID: 36521378 PMCID: PMC9772847 DOI: 10.1016/j.neo.2022.100860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Primary central nervous system (CNS) germ cell tumors (GCT) are a rare heterogenous group of cancers, arising most commonly in the second decade of life. Through several clinical trials conducted around the world by various groups, the treatment approach for CNS GCT has advanced substantially with generally improved overall outcomes. In recent years, the goal of clinical trials has been focused on reduction of the radiotherapy burden and minimization of long-term toxicity. This review summarizes the current diagnostic and treatment regimens for CNS GCT, examines the controversies associated with these approaches, gaps in contemporary knowledge, and underscores the challenges we face. We also explore future directions in the management of CNS GCT with the ultimate overall aim of preserving curative outcomes, identifying novel biomarkers, and mitigating neurocognitive, endocrine, and psychological toxicity through prospective clinical studies.
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Affiliation(s)
- Kee Kiat Yeo
- Dana-Farber / Boston Children's Cancer and Blood Disorder Center, USA,Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Sumanth Nagabushan
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia,University of New South Wales, Randwick, New South Wales, Australia
| | - Girish Dhall
- The Alabama Center for Childhood Cancer and Blood Disorders at Children's of Alabama, Birmingham, USA,University of Alabama, Birmingham, USA,Corresponding author at: The Alabama Center for Childhood Cancer and Blood Disorders at Children's of Alabama, 1600 7th Avenue S, Lowder 512, Birmingham, AL 35233, USA.
| | - Mohamed S. Abdelbaki
- The Division of Hematology and Oncology, St. Louis Children's Hospital, Washington University, School of Medicine in St. Louis, Washington University, St. Louis, Missouri, USA,Co-corresponding author at: Washington University School of Medicine in St. Louis, 660 South Euclid Avenue – Campus Box 8116, St. Louis, MO 63110, USA.
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