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For: De B, Cahlon O, Dunkel IJ, De Braganca KC, Khakoo Y, Gilheeney SW, Souweidane MM, Wolden SL. Reduced-volume radiotherapy for patients with localized intracranial nongerminoma germ cell tumors. J Neurooncol 2017;134:349-56. [PMID: 28660318 DOI: 10.1007/s11060-017-2532-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/21/2017] [Indexed: 12/16/2022]

For:	De B, Cahlon O, Dunkel IJ, De Braganca KC, Khakoo Y, Gilheeney SW, Souweidane MM, Wolden SL. Reduced-volume radiotherapy for patients with localized intracranial nongerminoma germ cell tumors. J Neurooncol 2017;134:349-56. [PMID: 28660318 DOI: 10.1007/s11060-017-2532-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/21/2017] [Indexed: 12/16/2022]

Number

Cited by Other Article(s)

Wen L, Li J, Lai M, Zhou Z, Hu Q, Deng G, Shan C, Ai R, Li H, Lu M, Zhang L, Wu T, Zhu D, Chen Y, Chen L, Cai L, Zhou C. Survival outcomes, hematologic complications and growth impairment after sequential chemoradiotherapy in intracranial NGGCTs: a retrospective study. Strahlenther Onkol 2021;198:458-467. [PMID: 34673990 DOI: 10.1007/s00066-021-01857-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]

Abstract

PURPOSE

This study aimed to evaluate the clinical features, prognostic factors, and survival outcomes for patients with intracranial nongerminomatous germ cell tumors (NGGCTs), with a particular focus on treatment toxicity for long-term survivors.

METHODS

Intracranial NGGCTs treated with platinum-based chemotherapy and craniospinal irradiation (CSI) in our institution were retrospectively analyzed. Hematological complications following sequential chemoradiotherapy as well as height and weight in childhood survivors were evaluated. Plasma growth hormone (GH) concentrations prior to and after radiotherapy were obtained for the comparisons.

RESULTS

A total of 111 intracranial NGGCTs were included. The 3‑year overall survival (OS) and event-free survival (EFS) rates were 83.5% ± 3.9% and 71.0% ± 4.8%, respectively. A combined treatment modality consisting of ≥ 4 cycles of platinum-based chemotherapy and CSI was associated with an improved OS (P = 0.003) and EFS (P < 0.001). Thrombocytopenia of any grade occurred in 35.4% (34/96) of patients, and the threshold age for an increased risk of thrombocytopenia was 14 years (area under the curve AUC = 0.752, P < 0.0001) as derived from receiver operating characteristic (ROC) analysis. Growth impediment was found in 8 of 56 (14%) patients. The age for receiving radiotherapy was found to inversely correlate with height development, revealing a cut-off age of 11.5 years for risking growth impairment (AUC = 0.806, P = 0.004). Consistently, a significant decline in plasma growth hormone after radiotherapy was observed in patients ≤ 11.5 years (P < 0.01) but not patients > 11.5 years. (P > 0.05).

CONCLUSION

Our study suggested that a combined treatment modality with at least four cycles of chemotherapy and CSI was safe and effective for patients with intracranial NGGCTs. Radiotherapy should be used with caution for patients < 11.5 years due to growth impairment.

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Kumar N, Madan R, Dracham CB, Khosla D, Das N, Dey T, Elangovan A, Tripathi M, Gupta K, Ahuja CK, Kapoor R. Multimodality treatment for Central Nervous System Germ Cell Tumors: Disease spectrum and management strategies - A tertiary care center experience from India. Clin Neurol Neurosurg 2021;202:106481. [PMID: 33508649 DOI: 10.1016/j.clineuro.2021.106481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 01/09/2023]

Abstract

OBJECTIVE

Intracranial germ cell tumors (GCTs) are relatively rare neoplasms, representing 2-3 % of paediatric brain tumors in Western countries and 8-15 % in East Asia. Here, we discuss the clinical features and treatment outcomes in patients with central nervous system (CNS) GCTs treated at our institute.

METHODS

Medical records of all primary CNS GCT patients were retrieved retrospectively from 2007 to 2019. Demographic, clinical, treatment and follow up details were entered in a predesigned proforma. Overall survival (OS) and progression-free survival was computed using Kaplan-Meier method and Log-Rank test. Effect of various prognostic factors on survival outcomes was assessed by univariate and multivariate analysis.

RESULTS

A total of 28 CNS GCT patients were included in this analysis. Median age at presentation was 17 years (range, 7-45 years) with a male to female ratio of 1.8:1. Pineal region was the commonest location, encountered in 15 patients (53.6 %). Pure germinoma was the most frequent histology observed, seen in 19 patients (67.9 %). Male gender and germinoma histology were highly associated with pineal location (p = 0.043 and p = 0.052, respectively). Fourteen patients underwent surgical intervention and nine patients underwent biopsy for diagnostic purpose or to relieve the obstructive symptoms. Only 23 patients (82.1 %) received chemotherapy. However, all patients received radiotherapy (Craniospinal irradiation/whole brain radiotherapy/whole ventricular radiotherapy/ or local radiotherapy). After a median follow-up of 53 months (range, 7-150), 23 patients (82.1 %) were alive. OS was significantly affected by histology (89 % in germinoma vs. 60 % in non-germinomatous, p = 0.054) and location (93 % in pineal region vs. 64.2 % in other location, p = 0.042). Age, gender and surgery did not have any impact on the survival outcomes.

CONCLUSION

CNS GCTs are relatively rare and heterogeneous neoplasms commonly seen in pineal and suprasellar locations. A combination of chemotherapy and radiotherapy had shown excellent outcomes.

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Long term toxicity of intracranial germ cell tumor treatment in adolescents and young adults. J Neurooncol 2020;149:523-532. [PMID: 33034840 DOI: 10.1007/s11060-020-03642-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/01/2020] [Indexed: 12/12/2022]

Abstract

PURPOSE

The purpose of this study is to describe the long-term toxicities of intracranial germ cell tumor (IGCT) in the adolescent and young adult (AYA) population.

METHODS

We report late toxicities of a multi-center cohort of AYA patients treated for IGCT between 1975 and 2015. Charts were retrospectively reviewed for hormone deficiency, ototoxicity, seizure disorder, visual deterioration, cerebrovascular events, second neoplasm, psychiatric illness, and neurocognitive impairment. Statistical analysis was performed for late toxicities to evaluate the influence of select factors.

RESULTS

Our patient cohort included 112 patients with IGCTs; 84% of patients had a germinoma as opposed to a non-germinomatous germ cell tumor (NGGCT), median age at radiotherapy (RT) was 19 years, and median follow-up was 8.3 years. Of the 94 patients with germinoma, 32 (34%) received both chemotherapy and RT as part of their upfront treatment, while 62 (66%) received RT alone. All 18 patients with NGGCT received chemotherapy and RT. The most common late toxicity following IGCT treatments was physician-reported neurocognitive impairment, with a 10-year cumulative incidence (CI) of 38.5%. Ten-year CI of treatment-induced ototoxicity was 39.2% for patients who received cisplatin, compared to 3.6% for those who received carboplatin but no cisplatin (p < 0.005). Suprasellar/hypothalamic tumor location was associated with 10-year CI of treatment-induced hormone deficiency (36.1 vs 6.2%, p < 0.005).

CONCLUSIONS

A significant proportion of AYAs treated for IGCTs experience late effects from treatment, including neurocognitive impairment, ototoxicity, and hormone deficiency. Suprasellar/hypothalamic tumor location and cisplatin were associated with a higher risk of treatment-induced hormone deficiency and ototoxicity, respectively.

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Biassoni V, Schiavello E, Gandola L, Pecori E, Poggi G, Spreafico F, Terenziani M, Meazza C, Podda M, Ferrari A, Luksch R, Casanova M, Puma N, Chiaravalli S, Bergamaschi L, Cefalo G, Simonetti F, Gattuso G, Seregni EC, Pallotti F, Gianno F, Diletto B, Barretta F, Massimino M. Secreting Germ Cell Tumors of the Central Nervous System: A Long-Term Follow-up Experience. Cancers (Basel) 2020;12:cancers12092688. [PMID: 32967085 PMCID: PMC7565315 DOI: 10.3390/cancers12092688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 09/13/2020] [Indexed: 11/16/2022] Open

Affiliation(s)

Veronica Biassoni Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.) Correspondence: ; Tel.: +39-0223902590; Fax: +39-0223902648
Elisabetta Schiavello Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
Lorenza Gandola Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (L.G.); (E.P.); (B.D.)
Emilia Pecori Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (L.G.); (E.P.); (B.D.)
Geraldina Poggi Neuro-Oncological Unit and Neuropsychological Rehabilitation Unit Scientific Institute, IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy;
Filippo Spreafico Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
Monica Terenziani Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
Cristina Meazza Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
Marta Podda Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
Andrea Ferrari Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
Roberto Luksch Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
Michela Casanova Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
Nadia Puma Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
Stefano Chiaravalli Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
Luca Bergamaschi Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
Graziella Cefalo Department of Pediatrics, University of Milan, San Paolo Hospital, Santi Paolo e Carlo ASST, 20121 Milan, Italy;
Fabio Simonetti Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
Giovanna Gattuso Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
Ettore Cesare Seregni Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.C.S.); (F.P.)
Federica Pallotti Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.C.S.); (F.P.)
Francesca Gianno Department of Radiological, Oncological and Anatomo-Pathological Sciences, University Sapienza of Rome, 00161 Rome, Italy;
Barbara Diletto Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (L.G.); (E.P.); (B.D.)
Francesco Barretta Clinical Epidemiology and Trial Organization Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
Maura Massimino Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)

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Intracranial Germ Cell Tumors in Adolescents and Young Adults: A 40-Year Multi-Institutional Review of Outcomes. Int J Radiat Oncol Biol Phys 2020;106:269-278. [DOI: 10.1016/j.ijrobp.2019.10.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/26/2019] [Accepted: 10/14/2019] [Indexed: 11/23/2022]

de Rezende ACP, Weltman E, Chen MJ, Helito JK, de Carvalho ÍT, Sakuraba RK, Silva NS, Cappellano AM, Hamerschlak N. Intensity-modulated ventricular irradiation for intracranial germ-cell tumors: Survival analysis and impact of salvage re-irradiation. PLoS One 2019;14:e0226350. [PMID: 31860688 PMCID: PMC6924640 DOI: 10.1371/journal.pone.0226350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/25/2019] [Indexed: 12/25/2022] Open

Abu Arja MH, Bouffet E, Finlay JL, AbdelBaki MS. Critical review of the management of primary central nervous nongerminomatous germ cell tumors. Pediatr Blood Cancer 2019;66:e27658. [PMID: 30767415 DOI: 10.1002/pbc.27658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/06/2019] [Accepted: 01/27/2019] [Indexed: 12/28/2022]

Abu Arja MH, Stanek JR, Finlay JL, AbdelBaki MS. Re-induction chemotherapy regimens in patients with recurrent central nervous system mixed malignant germ cell tumors. Childs Nerv Syst 2018;34:2179-2186. [PMID: 30076436 DOI: 10.1007/s00381-018-3940-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/31/2018] [Indexed: 12/27/2022]

Abstract

BACKGROUND

The lack of a standard treatment approach has contributed to poor outcomes of patients with recurrent central nervous system (CNS) mixed malignant germ cell tumors (MMGCT). There are no data in the literature supporting optimal re-induction chemotherapy regimens that should be used for patients with recurrent CNS MMGCT.

METHODS

We conducted a literature review to explore the response rate of patients with recurrent CNS MMGCT to different re-induction chemotherapy regimens by searching PubMed from 1985 through November 2017. Tumors were classified according to Japanese, European, and North American prognostic group classifications determined at initial presentation.

RESULTS

Forty-two responses to various re-induction chemotherapy regimens reported in 38 patients were included. Two patients were inevaluable and their responses to re-induction chemotherapy were excluded. Thirty-five responses to various re-induction chemotherapy regimens were evaluable in 33 patients following a first relapse. Six (17%) responses were reported as complete or continuous complete responses, seven (20%) partial responses, two (6%) were stable disease, two (6%) were mixed responses, and 18 (51%) were progressive disease. Five of ten patients treated without platinum-based chemotherapy experienced tumor progression. There was a trend towards a higher rate of tumor progression among histological poor prognostic group patients, and among patients relapsing within 24 months of initial diagnosis; however, it was not statistically significant.

CONCLUSIONS

The histological prognostic group and time to relapse may affect the response to re-induction chemotherapy. However, further studies with larger sample size are needed to examine these associations and determine the optimal re-induction chemotherapy regimens for patients with recurrent MMGCT.

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