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Yao DC, Ye BK, Yao DJ, Guo CC. A novel lactate dehydrogenase-based risk score model to predict the prognosis of primary central nervous system germ cell tumor treated with chemoradiotherapy. Clin Neurol Neurosurg 2024; 236:108081. [PMID: 38091701 DOI: 10.1016/j.clineuro.2023.108081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 12/06/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND The prognostic role of lactate dehydrogenase (LDH) has been confirmed in many malignant tumors, but the role of serum LDH in primary central nervous system germ cell tumor (GCT) remains unknown. This study aimed to assess the prognostic value of LDH in GCT patients and develop a nomogram to predict prognosis in patients undergoing chemoradiotherapy. METHODS A total of 161 patients with GCT were included in this study. Using a restricted cubic spline (RCS) model, the optimal cutoff point for LDH was determined to be 217 U/L. The survival of GCT patients was evaluated using the Kaplan-Meier method and log-rank test to analyze the effects of LDH levels. Univariate Cox regression, multivariate Cox regression, and LASSO Cox regression were conducted to identify prognostic factors, which were incorporated into a nomogram for predicting overall survival (OS). The predictive accuracy of the nomogram was assessed using the C-index, calibration curve, area under the time-dependent receiver operating characteristic curve (time-dependent AUC), and risk group stratification. The net benefits of the nomogram at different threshold probabilities were quantified using decision curve analysis (DCA). RESULTS The high-LDH group had significantly shorter OS compared to the low-LDH group (P = 0.016). Based on the SYSUCC cohort, three variables were shown to be significant factors for OS and were incorporated in the nomogram: LDH, histopathology, and dissemination. It showed good discrimination ability, with C-index of 0.789 (95% CI, 0.671-0.907). Additionally, the clinical usefulness of the nomogram was confirmed by calibration curves and time-dependent AUC. DCA further highlighted the potential of the nomogram to guide clinical treatment strategies for patients. Moreover, there was a significant difference in OS among patients categorized into different risk groups (P < 0.001). CONCLUSION LDH levels may serve as a reliable predictor for assessing the therapeutic effect of chemoradiotherapy in GCT. The developed nomogram exhibits high accuracy in predicting survival outcomes, aiding in the classification of prognostic groups, and supporting informed clinical decision-making.
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Affiliation(s)
- Dun-Chen Yao
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China
| | - Bao-Kui Ye
- Department of Intensive Care Unit, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China
| | - Dong-Jie Yao
- Department of Neurology, Zhenyuan County Hospital, Zhenyuan, China
| | - Cheng-Cheng Guo
- Department of Neurosurgery/Neuro-Oncology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China..
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Zeng C, Yang Q, Li Z, Wei Z, Chen T, Deng M, Wang J, Wang J, Sun F, Huang J, Lu S, Zhu J, Sun X, Zhen Z. Treatment outcomes for response-based radiotherapy in children and adolescents with central nervous system germinoma: a prospective study. J Neurooncol 2023; 164:643-653. [PMID: 37768471 DOI: 10.1007/s11060-023-04453-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE The optimal dose and range of radiotherapy for central nervous system (CNS) germinoma have not yet been established. This study aimed to investigate the effects of individualized radiotherapy on the prognosis of patients with germinoma. METHODS Based on imaging examination, tumor markers, and pathologic results, patients with germinoma received different radiotherapy strategies, including R1 (24 Gy whole ventricular irradiation + tumor-bed boost to 40 Gy), R2 (24-30 Gy craniospinal irradiation + tumor-bed boost to 54 Gy), R3 (24 Gy craniospinal irradiation + tumor-bed boost to 40 Gy), and R4 (30 Gy craniospinal irradiation + tumor-bed boost to 54 Gy with 45 Gy to spinal metastasis). RESULTS A total of 77 patients were enrolled in this study between January 2015 and March 2021. The 3-year event-free survival (EFS) and overall survival (OS) of the whole cohort were 94.7% ± 2.6% and 96.0% ± 2.3%, respectively. The 3-year EFS for patients with localized and metastatic disease were 96.6% ± 2.4% and 89.2% ± 7.2%, respectively. The 3-year EFS of patients receiving R1, R2, R3, and R4 radiotherapy were 100%, 94.1% ± 5.7%, 100%, and 86.2% ± 9.1%, respectively. CONCLUSION Good prognosis was still achieved after reducing dose and extent of radiation for the patients who achieved complete response (CR) after induction chemotherapy or pathological CR after second-look surgery.
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Affiliation(s)
- Chenggong Zeng
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Qunying Yang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of neurosurgery, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Zhuoran Li
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Zhiqing Wei
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Tingting Chen
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Meiling Deng
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Jian Wang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of neurosurgery, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Juan Wang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Feifei Sun
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Junting Huang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Suying Lu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Jia Zhu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Xiaofei Sun
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
| | - Zijun Zhen
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
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Tsurubuchi T, Hara K, Takano S, Muroi A, Fukushima H, Mizumoto M, Sakamoto N, Matsuda M, Akutsu H, Sakurai H, Ishikawa E. Factors Influencing Craniospinal Relapse of Intracranial Germinoma After Complete Remission. World Neurosurg 2022; 166:e325-e336. [PMID: 35842173 DOI: 10.1016/j.wneu.2022.07.010] [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: 04/08/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the pathomechanism of the recurrence of intracranial germinoma after complete response and to confirm the association of the initial magnetic resonance imaging and therapeutic factors with recurrence. METHODS This study included patients who were followed up for ≥5 years and who were treated in our hospital from 1980 to 2021. Those with germinoma and germinoma with syncytiotrophoblastic giant cells were diagnosed pathologically. Data were categorizedbased on "gender," "single region," "intraventricular dissemination at the initial diagnosis," "hydrocephalus," "types of radiation therapy (RT)," and "chemotherapy." Fisher's exact probability test was used to assess differences between the no recurrence and recurrence groups. RESULTS Among 43 patients, 34 had no recurrence, 5 had delayed recurrence (≥60 months), and 4 had early recurrence (<60 months). Follow-up periods were 143.5 (60-380), 198 (88-222), and 132.5 (75-291) months for the no recurrence, delayed recurrence, and early recurrence groups, respectively. Five patients with delayed recurrence showed 3 intracranial lesions and 2 spinal lesions. Four patients with early recurrence showed 3 intracranial lesions and 1 spinal lesion. Differences in delayed recurrences (focal RT vs. RT including whole-ventricle system; P = 0.0491) were significant in Fisher's exact test. CONCLUSIONS RT including the whole-ventricle system reduces delayed craniospinal relapses including dissemination, local, and distant recurrences even ≥5 years after complete response in patients with primary central nervous system germinoma.
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Affiliation(s)
- Takao Tsurubuchi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Kei Hara
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Shingo Takano
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ai Muroi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroko Fukushima
- Department of Pediatrics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Noriaki Sakamoto
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; Department of Diagnostic Pathology, University of Tsukuba, Tsukuba, Japan
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroyoshi Akutsu
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; Department of Neurosurgery, Dokkyo Medical University, Shimotsuga, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Kang YM, Lee YY, Lin SC, Chang FC, Hsu SPC, Lin CF, Liang ML, Chen HH, Wong TT, Lan KL, Chao Y, Chen YW. Bifocal lesions have a poorer treatment outcome than a single lesion in adult patients with intracranial germinoma. PLoS One 2022; 17:e0264641. [PMID: 35231071 PMCID: PMC8887760 DOI: 10.1371/journal.pone.0264641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/14/2022] [Indexed: 11/18/2022] Open
Abstract
Intracranial germinoma (IG) rarely occurs in adults. Its optimal treatment strategy is unclear. We evaluated the outcomes of radiotherapy in adults with intracranial germinoma. Data of 29 adult patients (age, 18–52 years; median age, 24.3 years) with IG treated with radiotherapy at Taipei Veterans General Hospital were retrospectively reviewed. They were followed up for a median time of 5.9 years (range, 1.0–12.8 years). We used the Kaplan–Meier method to estimate the progression-free survival (PFS) and overall survival (OS), and univariate and multivariate Cox proportional hazards regression models to identify the factors affecting PFS. PFS and OS were compared between adult and pediatric patients with IG. The 1-, 3-, and 5-year PFS rates were 96.6%, 85.8%, and 77.8%, respectively, in the adult patients, and the OS rate were all 100%. Seven patients (24.1%) experienced recurrence, and in six of them, salvage therapy successfully controlled the disease. Two patients (6.9%) died after 5 years of follow-up due to disease progression and central pontine myelinolysis. In the univariate and multivariate Cox analysis, bifocal lesions had a significantly lower PFS than those with single lesions (p = 0.008). Kaplan–Meier survival analysis showed that adult patients had a poorer PFS (p = 0.06) and OS (p = 0.025) than pediatric patients. Our study showed bifocal lesions were associated with lower PFS than a single lesion among adult IG patients, and adult IG patients tended to have poorer PFS and OS compared to pediatric IG patients. For adult patients with bifocal IG, we recommend treatment with craniospinal irradiation, whole ventricle irradiation (WVI) with chemotherapy, or frequent spine images follow-up for patients who received only WVI.
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Affiliation(s)
- Yu-Mei Kang
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Yen Lee
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Chieh Lin
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Feng-Chi Chang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sanford P. C. Hsu
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Fu Lin
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Muh-Lii Liang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Hung Chen
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tai-Tong Wong
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Keng-Li Lan
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yee Chao
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Wei Chen
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu City, Taiwan
- * E-mail:
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Koh KN, Wong RX, Lee DE, Han JW, Byun HK, Yoon HI, Kim DS, Lyu CJ, Kang HJ, Hong KT, Lee JH, Kim IH, Phi JH, Kim SK, Wong TT, Lee HL, Lai IC, Kang YM, Ra YS, Ahn SD, Im HJ, Looi WS, Low SYY, Tan EEK, Park HJ, Shin SH, Fuji H, Suh CO, Chen YW, Kim JY. Outcomes of intracranial germinoma-A retrospective multinational Asian study on effect of clinical presentation and differential treatment strategies. Neuro Oncol 2021; 24:1389-1399. [PMID: 34935949 PMCID: PMC9340637 DOI: 10.1093/neuonc/noab295] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This multinational study was conducted to report clinical presentations and treatment strategies in patients with intracranial germinomas across selected Asian centers, including failure patterns, risk factors, and outcomes. METHODS A retrospective data collection and analysis of these patients, treated between 1995 and 2015 from eight healthcare institutions across four countries was undertaken. RESULTS From the results, 418 patients were analyzed, with a median follow-up of 8.9 years; 79.9% of the patients were M0, and 87.6% had β-human chorionic gonadotropin values <50 mIU/mL. The 5/10-year overall survival (OS) and recurrence-free survival (RFS) rates were 97.2%/96.2% and 89.9%/86.9%, respectively. RFS was predicted by the radiotherapy (RT) field, with focal RT having the worst outcome, whereas chemotherapy usage had no impact on survival. Among patients who received chemotherapy, response to chemotherapy did not predict survival outcomes. In M0 patients, primary basal ganglia tumors predicted a worse RFS. In patients with bifocal tumors, an extended field RT was associated with better outcomes. In multivariable analysis, only RT fields were associated with RFS. In relapsed patients, salvage rates were high at 85.7%. Additionally, patients who received salvage RT had a better outcome (91.6% vs. 66.7%). CONCLUSIONS Survival outcomes of patients with germinoma were excellent. Thus, the focus of treatment for intracranial germinoma should be on survivorship. Further studies are warranted to find the optimal intensity and volume of radiation, including the role of chemotherapy in the survival of patients with intracranial germinomas, considering age, primary tumor location, and extent of disease.
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Affiliation(s)
| | | | - Dong-Eun Lee
- Division of Cancer Epidemiology and Management, Research Institute, National Cancer Center, Goyang, Korea
| | - Jung Woo Han
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Hwa Kyung Byun
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Dong-Seok Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Chuhl Joo Lyu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Hyoung Jin Kang
- Departments of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Taek Hong
- Departments of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tai-Tong Wong
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Lun Lee
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - I-Chun Lai
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Mei Kang
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Young-Shin Ra
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Joon Im
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Wen Shen Looi
- Department of Radiation Oncology, National Cancer Centre, Singapore, Singapore
| | - Sharon Yin Yee Low
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore,Neurosurgical Service, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Enrica Ee Kar Tan
- Department of Pediatric Subspecialties, Pediatric Hematology/Oncology Service, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Hyun Jin Park
- Center for Pediatric Oncology, National Cancer Center, Goyang, Korea
| | - Sang Hoon Shin
- Neuro-Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Hiroshi Fuji
- Department of Radiation Oncology, National Center for Child Health and Development, Tokyo, Japan
| | - Chang-Ok Suh
- Department of Radiation Oncology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Yi-Wei Chen
- Yi-Wei Chen, MD, PhD, Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Rd., Taipei 112, Taiwan ()
| | - Joo-Young Kim
- Corresponding Authors: Joo-Young Kim, MD, PhD, Department of Radiation Oncology, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Insandong-gu, Goyang, Gyeonggi-do 10408, Korea ()
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6
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Vij M, Bhardwaj S. Primary spinal dorsal extramedullary germ cell tumor: A rare case report and literature review. Surg Neurol Int 2021; 12:603. [PMID: 34992920 PMCID: PMC8720437 DOI: 10.25259/sni_575_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/04/2021] [Indexed: 11/06/2022] Open
Abstract
Background: Primary spinal extramedullary germ cell tumor are very rare. Germ cell tumor are similar histologically to germ cells of genital organs and may arise rarely from central and peripheral nervous system. Case Description: We report a case of 20-year-old male who presented with progressive lower extremity weakness, spasticity, and numbness of legs. Patient was evaluated with magnetic resonance imaging dorsal spine which revealed extramedullary mass in dorsal (D2-D3) level with severe cord compression. Tumor was found to be extramedullary with histopathology consistent with germ cell tumor. Patient was given radiotherapy and chemotherapy postoperatively. Conclusion: Primary spinal extramedullary germ cell tumors are very rare and are very sensitive to radiation and chemotherapy. Various management and treatment protocols are available across institutions in the world. We recommend adequate decompression of cord with biopsy followed by local radiation and chemotherapy. As these are rare tumors, presenting with significant neurological deficits should always be kept in the differential diagnosis.
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Affiliation(s)
- Mukesh Vij
- Department of Neurosurgery, EMC Super Speciality Hospital, Amritsar, Punjab, India
| | - Sandeep Bhardwaj
- Department of Neurosurgery, Advanced Neurology and Superspeciality Hospital, Jaipur, Rajasthan, India
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7
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Pediatric Suprasellar Germ Cell Tumors: A Clinical and Radiographic Review of Solitary vs. Bifocal Tumors and Its Therapeutic Implications. Cancers (Basel) 2020; 12:cancers12092621. [PMID: 32937871 PMCID: PMC7565935 DOI: 10.3390/cancers12092621] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023] Open
Abstract
Suprasellar germ cell tumors (S-GCTs) are rare, presenting in either solitary or multifocal fashion. In this study, we retrospectively examine 22 solitary S-GCTs and 20 bifocal germ cell tumors (GCTs) over a 30-year period and demonstrate clinical, radiographic, and prognostic differences between the two groups with therapeutic implications. Compared to S-GCTs, bifocal tumors were almost exclusively male, exhibited higher rate of metastasis, and had worse rates of progression free and overall survival trending toward significance. We also introduce a novel magnetic resonance (MR) imaging classification of suprasellar GCT into five types: a IIIrd ventricle floor tumor extending dorsally with or without an identifiable pituitary stalk (Type Ia, Ib), ventrally (Type III), in both directions (Type II), small lesions at the IIIrd ventricle floor extending to the stalk (Type IV), and tumor localized in the stalk (Type V). S-GCTs almost uniformly presented as Type I-III, while most bifocal GCTs were Type IV with a larger pineal mass. These differences are significant as bifocal GCTs representing concurrent primaries or subependymal extension may be treated with whole ventricle radiation, while cerebrospinal fluid (CSF)-borne metastases warrant craniospinal irradiation (CSI). Although further study is necessary, we recommend CSI for bifocal GCTs exhibiting high-risk features such as metastasis or non-germinomatous germ cell tumor histology.
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Li B, Lv W, Li C, Yang J, Chen J, Feng J, Chen L, Ma Z, Li Y, Wang J, Liu Y, Li Y, Liu S, Luo S, Qiu X. Comparison between Craniospinal Irradiation and Limited-Field Radiation in Patients with Non-metastatic Bifocal Germinoma. Cancer Res Treat 2020; 52:1050-1058. [PMID: 32646203 PMCID: PMC7577802 DOI: 10.4143/crt.2020.437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/08/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Whether craniospinal irradiation (CSI) could be replaced by limited-field radiation in non-metastatic bifocal germinoma remains controversial. We addressed the issue based on the data from our series and the literature. Materials and Methods Data from 49 patients diagnosed with non-metastatic bifocal germinoma at our hospital during the last 10 years were collected. The Pediatric Quality of Life Inventory 4.0 was used to evaluate health-related quality of life (HRQOL). Additionally, 81 patients identified from the literature were also analyzed independently. RESULTS In our cohort, 34 patients had tumors in the sellar/suprasellar (S/SS) plus pineal gland (PG) regions and 15 in the S/SS plus basal ganglia/thalamus (BG/T) regions. The median follow-up period was 52 months (range, 10 to 134 months). Our survival analysis showed that patients treated with CSI (n=12) or whole-brain radiotherapy (WBRT; n=34) had comparable disease-free survival (DFS; p=0.540), but better DFS than those treated with focal radiotherapy (FR; n=3, p=0.016). All 81 patients from the literature had tumors in the S/SS+PG regions. Relapses were documented in 4/45 patients treated with FR, 2/17 treated with whole-ventricle irradiation, 0/4 treated with WBRT, and 1/15 treated with CSI. Survival analysis did not reveal DFS differences between the types of radiation field (p=0.785). HRQOL analysis (n=44) in our cohort found that, compared with S/SS+PG germinoma, patients with BG/T involvement had significantly lower scores in social and school domains. However, HRQOL difference between patients treated with CSI and those not treated with CSI was not significant. CONCLUSION In patients with non-metastatic bifocal germinoma, it is rational that CSI could be replaced by limited-field radiation. HRQOL in patients with BG/T involvement was poorer.
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Affiliation(s)
- Bo Li
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Wenyi Lv
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunde Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiongxian Yang
- Department of Clinical Nutrition, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jiajia Chen
- Centre of Endocrinology Genetics and Metabolism, National Centre for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jin Feng
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li Chen
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhenyu Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youqi Li
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiayi Wang
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanwei Liu
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanong Li
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuai Liu
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiqi Luo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoguang Qiu
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
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Chung SY, Han JW, Kim DS, Yoon HI, Suh CO. Treatment outcomes based on radiation therapy fields for bifocal germinoma: Synchronous or disseminated disease? PLoS One 2019; 14:e0223481. [PMID: 31581215 PMCID: PMC6776334 DOI: 10.1371/journal.pone.0223481] [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: 02/20/2019] [Accepted: 09/23/2019] [Indexed: 12/26/2022] Open
Abstract
Intracranial germinoma sometimes present as bifocal germinoma, and whether bifocal germinoma should be treated as a synchronous or disseminated disease remains unclear. This study aimed to determine the optimal treatment modality for bifocal germinoma. Patients with bifocal germinoma who received radiotherapy (RT) from March 1990 to August 2017 were included for analysis. A total of 21 patients were included. The median follow-up period was 76.2 months (range, 6.2-305.4 months). There were 17 patients who received cranio-spinal irradiation (CSI) with local RT; 3, whole ventricular RT (WVRT) with local RT; and 1, local RT only. Three recurrences occurred (1 patient each among those who underwent CSI, WVRT, and local RT). Recurrence in the patient who received CSI and who received WVRT occurred in the right thalamus and right frontal convexity, respectively. Meanwhile, the patient who received local RT showed not only a recurred lesion in the hypothalamus, but also cerebrospinal fluid seeding. For this patient, salvage CSI was performed and complete response was achieved after treatment. However, after 9 years and 6 months, he was diagnosed with glioblastoma and expired. As for toxicity, although 17 patients showed decrease in complete blood count levels during treatment, all patients recovered soon after treatment completion. Our findings suggest that bifocal germinoma may be considered as a disseminated disease when considering the patterns of failure according to RT fields. In addition, patients who received CSI showed low acute toxicity rates. However, further studies are necessary to confirm these findings.
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Affiliation(s)
- Seung Yeun Chung
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung Woo Han
- Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong-Seok Kim
- Department of Pediatric Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, South Korea
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10
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Treatment outcomes of intracranial germinoma: a retrospective analysis of 170 patients from a single institution. J Cancer Res Clin Oncol 2018; 145:709-715. [PMID: 30209611 DOI: 10.1007/s00432-018-2743-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To perform a retrospective analysis of patients with intracranial germinoma treated in our department to evaluate treatment outcomes and determine optimal treatment strategies. METHODS We reviewed the treatment outcomes of 170 patients with intracranial germinoma who were treated in our department from January 1996 to January 2017. The median patient age was 15 years old. Among the patients, 56 (33%) were pathologically diagnosed, and 114 (67%) were diagnosed clinically. Various radiation fields and doses were used. Cerebrospinal fluid (CSF) and serum beta-human chorionic gonadotropin (β-HCG) levels were examined before treatment in 114 patients. Endocrinological evaluation was performed in 141 patients before and after treatment. A total of 38 patients received chemotherapy prior to radiotherapy (RT). The median follow-up time was 64.5 months (range 4-260.5 months). RESULTS The 5- and 10-year overall survival (OS) rates were 94.5% and 91.3%, respectively. The relapse-free survival (RFS) rates at 5- and 10-years were 91.9% and 78.1%, respectively. Relapses occurred in 18 patients within 6 months-10 years. The spinal cord metastasis rate was 3.4% in patients with a localized lesion who did not receive spinal cord irradiation and 16.7% in patients with bifocal disease who were treated using whole ventricular irradiation (WVI) or whole brain radiotherapy (WBRT). Treatment failure did not occur in patients receiving chemoradiotherapy or in patients receiving three-dimensional conformal radiation therapy (3D-CRT)/intensity-modulated radiation therapy (IMRT). The RFS rate did not have a statistically significant correlation with the CSF/serum β-HCG level. After RT, 19.1% of the patients developed newly impaired pituitary function and required hormone replacement therapy. CONCLUSIONS WVI or WBRT+ primary boost (PB) is a sufficient irradiation field for localized intracranial germinoma, while patients with bifocal disease should undergo craniospinal irradiation (CSI), especially when treated with RT alone. CSF β-HCG is not a prognostic marker for intracranial germinomas. The treatment results of chemotherapy followed by reduced-dose RT are comparable to those of RT alone. IMRT is recommended for intracranial germinoma to improve the target volume accuracy and decrease the complications of RT.
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11
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Jain TK, Basher RK, Sood A, Mittal BR, Prakash G, Bhatia A. 18F-FDG PET/CT Finding of Drop Metastases from Germ Cell Tumor of Pineal Gland. J Nucl Med Technol 2017; 45:114-115. [DOI: 10.2967/jnmt.116.185850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 02/03/2017] [Indexed: 11/16/2022] Open
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12
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Nikitović M, Grujičić D, Skender Gazibara M, Stanić D, Bokun J, Sarić M. Intramedullary Spinal Cord Germinoma: A Case Report and Review of Literature. World Neurosurg 2016; 95:392-398. [PMID: 27554307 DOI: 10.1016/j.wneu.2016.08.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 11/19/2022]
Abstract
Primary spinal cord germinomas are an extremely rare group of tumors, most commonly reported as single cases in young Japanese adults. They usually present as intramedullary lesions located in the thoracic and thoracolumbar spine. The importance of preoperative diagnosis lies in the fact that by using radiotherapy and chemotherapy, even without surgery, a good cure rate can be achieved in patients with spinal cord germinoma. These tumors, however, demonstrate unspecific imaging characteristics, and only some secrete tumor markers. Therefore, a diagnosis of these lesions before biopsy or resection with pathohistologic examination can be difficult. We present a case of a 28-year-old white man with intramedullary spinal cord germinoma. The tumor was resected completely with electrophysiological monitoring, without a biopsy and frozen section analysis. Postoperative radiotherapy also was part of the treatment. The patient has had no relapse 4.5 years after diagnosis; however, significant neurologic deficits remain. Although not as frequent in white patients, germinoma should be considered as differential diagnosis in cases of young adult patients with intramedullary tumor in the thoracic or thoracolumbar spine. Therefore, spinal mass surgery should commence with a biopsy and intraoperative frozen section analysis. In this way, attempting a gross total resection becomes unnecessary. With an approach of intraoperative biopsy and frozen section analysis, a considerable amount of postoperative neurologic deficits can be reduced.
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Affiliation(s)
- Marina Nikitović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute for Oncology and Radiology of Serbia, Clinic for Radiation Oncology, Belgrade, Serbia.
| | - Danica Grujičić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic of Neurosurgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - Milica Skender Gazibara
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute of Pathology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragana Stanić
- Institute for Oncology and Radiology of Serbia, Clinic for Radiation Oncology, Belgrade, Serbia
| | - Jelena Bokun
- Institute for Oncology and Radiology of Serbia, Clinic for Radiation Oncology, Belgrade, Serbia
| | - Milan Sarić
- Institute for Oncology and Radiology of Serbia, Clinic for Radiation Oncology, Belgrade, Serbia
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The necessity of long-term follow-up including spinal examination after successful initial treatment of intracranial germinoma: case reports. Childs Nerv Syst 2016; 32:547-51. [PMID: 26351071 DOI: 10.1007/s00381-015-2872-6] [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: 12/15/2014] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Intracranial germinomas seldom recur at spinal space following whole-brain or whole-ventricular (WV) radiotherapy. The majority of the spinal recurrence takes place within 5 years after treatment; therefore, late spinal failure beyond 5 years after successful initial treatment is rare. CASE PRESENTATIONS We describe the cases of two patients with intracranial germinoma, who developed spinal recurrence 7 and 9 years after the initial treatment with WV radiotherapy combined with and without chemotherapy, respectively. In both cases, spinal recurrent tumors were histologically diagnosed as germinoma and they were successfully treated with chemotherapy and local radiotherapy without tumor recurrence for 11 years and 11 months, respectively. CONCLUSION Intracranial germinomas may potentially present with spinal recurrence many years after successful initial WV radiotherapy. Physicians must be aware of patients' symptoms during the clinical examination. Regular long-term monitoring, including spinal examination, is necessary for 5-10 years or longer.
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Sivasubramaniam V, Zebian B, Thakur B, Saran F, Chandler C. Germinoma recurrence in the conus medullaris 12 years after remission of primary intracranial lesion in the pituitary. J Clin Neurosci 2015; 25:150-2. [PMID: 26642951 DOI: 10.1016/j.jocn.2015.06.024] [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: 05/27/2015] [Accepted: 06/01/2015] [Indexed: 10/22/2022]
Abstract
Intracranial germinomas are rare primary central nervous system tumours that are highly sensitive to radiotherapy and chemotherapy. Recurrences are infrequent, with the majority occurring within 5 years. Although multidisciplinary treatments have resulted in good event-free survival, long-term outcomes, over decades, are relatively poorly reported. We present a rare case of a recurrence in the conus medullaris 12 years after complete remission of the primary pituitary germinoma. To the best of our knowledge, this represents the first case of a significantly delayed spinal recurrence, occurring at a very distant and uncommon site, from the primary tumour. This case highlights the importance of long-term follow-up, even after complete remission, in order to identify and limit disability from late spinal recurrences in a relatively young patient population. We consider the literature regarding identifying high risk patients, and the role of craniospinal irradiation in limiting late spinal recurrences.
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Affiliation(s)
- Vinothan Sivasubramaniam
- Department of Neurosurgery, King's College Hospital, London, UK; Department of Neurosurgery, St George's Hospital, London, UK.
| | - Bassel Zebian
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Bhaskar Thakur
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Frank Saran
- Department of Neuro-oncology and Paediatric Oncology, The Royal Marsden NHS Foundation Trust, Surrey, UK
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15
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Results of sequential chemoradiotherapy for intracranial germinoma. Jpn J Radiol 2015; 33:336-43. [PMID: 25943790 DOI: 10.1007/s11604-015-0424-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the efficacy of sequential chemoradiotherapy (CRT) for intracranial germinoma by long-term follow-up. MATERIALS AND METHODS We retrospectively evaluated 23 consecutive intracranial germinoma patients without spinal dissemination, who had been treated by sequential CRT. All patients except for one were biopsied or surgically resected before treatment and all patients received both cranial and spinal magnetic resonance imaging. Three cycles of induction chemotherapy composed of etoposide and platinum agents were administered. The prescription of radiotherapy was 24 Gy per 12 fractions. No patients received spinal irradiation. RESULTS All patients accomplished CRT and achieved complete remission. No severe acute and late toxicities were observed. Median follow-up time was 11.8 years. The 5- and 10-year overall survival rates were 100 and 100 %, and relapse-free survival rates were 96 and 89 %, respectively. Three patients developed intracranial recurrence and all of them were successfully salvaged by additional CRT. All patients were alive without disease at final follow-up. CONCLUSION Treatment of 24 Gy of sequential CRT for intracranial germinoma might be promising as an alternative to radiotherapy alone. Spinal irradiation may not be necessary for patients who had no spinal dissemination and who were treated with CRT.
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16
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Radiation therapy in pediatric pineal tumors. Neurochirurgie 2015; 61:212-5. [PMID: 25612810 DOI: 10.1016/j.neuchi.2014.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 01/12/2014] [Accepted: 11/11/2014] [Indexed: 11/21/2022]
Abstract
Pineal tumor management in pediatric patients must be based on close co-operation between oncologists, surgeons, radiation oncologists, neurologists, ophthalmologists, and endocrinologists. Radiation therapy (RT) remains critical in most situations and should be assessed as soon as the diagnosis is made, in order to optimize the radiation technique. This paper will focus on RT modalities, indications, as well as modalities in main pediatric pineal tumors (germ cell tumors and pineal parenchyma tumors). RT modalities are presently being debated and new RT techniques (intensity-modulated RT, proton therapy etc.) that are now available for pineal lesions need to be evaluated. Radiation strategies are also controversial for germ cell tumors: cranio-spinal radiation versus chemotherapy followed by focal radiation, which also requires discussion.
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Huo L, Wang X, Allen PK, Wang L, Liao Y, Han Z, Shen L, Tu Q, Zhong M, Zhuang Y, Li J, Hong J. Predictors of long-term survival following postoperative radiochemotherapy for pathologically confirmed suprasellar germ cell tumors. Mol Clin Oncol 2014; 3:430-434. [PMID: 25798281 DOI: 10.3892/mco.2014.461] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/10/2014] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to evaluate the predictors of long-term survival following postoperative therapy for suprasellar germ cell tumors (GCTs). A total of 23 patients with pathologically confirmed suprasellar GCTs were reviewed between April, 1987 and October, 2008. The predictors were identified with a univariate Cox proportional hazards model and the results were used to group patients according to outcome. The overall survival (OS) and progression-free survival (PFS) rates for the good- and poor-prognosis two groups were estimated with Kaplan-Meier analysis, with log-rank tests used to assess differences between the groups. The OS rate for all patients was 82.6% at 5 and 72.9% at 10 years. Lesion size (2-4 vs. >4 cm) and pathological type (pure germinoma vs. mixed GCT) were the only significant predictors of OS (P<0.05). The OS rate for the good-prognosis group was 92.9% at both 5 and 10 years, whereas the corresponding rates for the poor-prognosis group were 66.7 and 40.0%, respectively (P=0.020). The PFS rate for the good-prognosis group was 92.9% at 5 and 85.7% at 10 years, whereas the corresponding PFS rates for the poor-prognosis group were 44.4 and 33.3%, respectively (P=0.007). Lesion size and histology predicted outcome following postoperative therapy for suprasellar GCT. Therefore, pathological diagnosis is recommended whenever possible, as histology may dictate the choice of treatment.
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Affiliation(s)
- Lei Huo
- Departments of Neurosurgery, Xiangya Hospital, Central South University, Institute of Skull Base Surgery and Neurooncology, Changsha, Hunan 410008, P.R. China
| | - Xia Wang
- Radiation Oncology, Xiangya Hospital, Central South University, Institute of Skull Base Surgery and Neurooncology, Changsha, Hunan 410008, P.R. China
| | - Pamela K Allen
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Longyun Wang
- Radiation Oncology, Xiangya Hospital, Central South University, Institute of Skull Base Surgery and Neurooncology, Changsha, Hunan 410008, P.R. China
| | - Yuping Liao
- Radiation Oncology, Xiangya Hospital, Central South University, Institute of Skull Base Surgery and Neurooncology, Changsha, Hunan 410008, P.R. China
| | - Zaide Han
- Department of Radiology, Xiangya Hospital, Central South University, Institute of Skull Base Surgery and Neurooncology, Changsha, Hunan 410008, P.R. China
| | - Liangfang Shen
- Radiation Oncology, Xiangya Hospital, Central South University, Institute of Skull Base Surgery and Neurooncology, Changsha, Hunan 410008, P.R. China
| | - Qingsong Tu
- Radiation Oncology, Xiangya Hospital, Central South University, Institute of Skull Base Surgery and Neurooncology, Changsha, Hunan 410008, P.R. China
| | - Meizuo Zhong
- Radiation Oncology, Xiangya Hospital, Central South University, Institute of Skull Base Surgery and Neurooncology, Changsha, Hunan 410008, P.R. China
| | - Yan Zhuang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jing Li
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jidong Hong
- Radiation Oncology, Xiangya Hospital, Central South University, Institute of Skull Base Surgery and Neurooncology, Changsha, Hunan 410008, P.R. China
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Al-Mahfoudh R, Zakaria R, Irvine E, Pizer B, Mallucci CL. The management of bifocal intracranial germinoma in children. Childs Nerv Syst 2014; 30:625-30. [PMID: 24092424 DOI: 10.1007/s00381-013-2287-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 09/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Bifocal intracranial germinoma (BFG) is a tumour of the pineal and suprasellar regions, which is known to be highly radiosensitive. The definitive treatment and outcomes are not well defined, particularly in the paediatric population. We review our series of purely paediatric cases from a single institution and combine them with the limited reports in the literature to determine the results of different management strategies. METHODS Four patients were treated at our institution with a median age of 15.3 years. A literature search identified a further 38 paediatric cases with a median age of 12.9 years. RESULTS All four patients had normal serum and CSF tumour markers. One patient had a diagnosis made based on imaging findings of bifocal pineal and suprasellar lesions presenting with diabetes insipidus. Three others underwent biopsy. All had craniospinal radiotherapy, which has led to complete cure with no cases of progression at a mean follow-up of 3 years. The most common treatment modality in published cases is craniospinal irradiation. In the cases reviewed, limited radiation treatments (whole ventricle or focal) combined with chemotherapy regimens yield comparable outcomes where there is no spinal dissemination. Outcomes do not appear to be altered by biopsy in cases with negative tumour markers and characteristic imaging appearances. CONCLUSION Patients who present with a classic appearance of germinoma, negative tumour markers and diabetes insipidus probably do not require a biopsy to confirm the diagnosis. No evidence of dissemination may obviate the need for craniospinal irradiation, but good quality long-term follow-up data are required to demonstrate the benefits of combined focal radiotherapy and chemotherapy regimes.
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Affiliation(s)
- R Al-Mahfoudh
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK,
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Primary spinal germ cell tumors: a case analysis and review of treatment paradigms. Case Rep Med 2013; 2013:798358. [PMID: 24312128 PMCID: PMC3838823 DOI: 10.1155/2013/798358] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/02/2013] [Accepted: 09/12/2013] [Indexed: 11/26/2022] Open
Abstract
Objective. Primary intramedullary spinal germ cell tumors are exceedingly rare. As such, there are no established treatment paradigms. We describe our management for spinal germ cell tumors and a review of the literature. Clinical Presentation. We describe the case of a 45-year-old man with progressive lower extremity weakness and sensory deficits. He was found to have enhancing intramedullary mass lesions in the thoracic spinal cord, and pathology was consistent with an intramedullary germ cell tumor. A video presentation of the case and surgical approach is provided. Conclusion. As spinal cord germinomas are highly sensitive to radiation and chemotherapy, a patient can be spared radical surgery. Diverse treatment approaches exist across institutions. We advocate biopsy followed by local radiation, with or without adjuvant chemotherapy, as the optimal treatment for these tumors. Histological findings have prognostic value if syncytiotrophoblastic giant cells (STGCs) are found, which are associated with a higher rate of recurrence. The recurrence rate in STGC-positive spinal germinomas is 33% (2/6), whereas it is only 8% in STGC-negative tumors (2/24). We advocate limited volume radiotherapy combined with systemic chemotherapy in patients with high risk of recurrence. To reduce endocrine and neurocognitive side effects, cranio-spinal radiation should be used as a last resort in patients with recurrence.
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Hu YW, Huang PI, Wong TT, Ho DMT, Chang KP, Guo WY, Chang FC, Shiau CY, Liang ML, Lee YY, Chen HH, Yen SH, Chen YW. Salvage Treatment for Recurrent Intracranial Germinoma After Reduced-Volume Radiotherapy: A Single-Institution Experience and Review of the Literature. Int J Radiat Oncol Biol Phys 2012; 84:639-47. [DOI: 10.1016/j.ijrobp.2011.12.052] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 12/06/2011] [Accepted: 12/13/2011] [Indexed: 11/30/2022]
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Paximadis P, Hallock A, Bhambhani K, Chu R, Sood S, Wang Z, Konski A. Patterns of failure in patients with primary intracranial germinoma treated with neoadjuvant chemotherapy and radiotherapy. Pediatr Neurol 2012; 47:162-6. [PMID: 22883279 DOI: 10.1016/j.pediatrneurol.2012.05.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 05/29/2012] [Indexed: 11/17/2022]
Abstract
External beam radiotherapy has proven effective in managing intracranial germinoma. However, concerns regarding long-term neurocognitive and endocrine sequelae led to the addition of chemotherapy, to reduce radiation target volumes. There is a paucity of data on patterns of failure in patients treated with differing radiation field sizes. We review our experience at a tertiary children's hospital treating children with intracranial germinoma, using induction chemotherapy followed by radiation therapy to various treatment volumes (craniospinal irradiation, whole ventricular irradiation, whole brain radiation therapy, and focal radiotherapy). Ten patients with primary intracranial germinoma, treated from November 1995-March 2011, were included. The primary treatment involved platinum-based chemotherapy, followed by definitive radiotherapy. The median follow-up period was 4.3 years (range, 0.75-13.25 years). The 5-year overall survival for the entire group was estimated at 85.7%, and the 5-year disease-free survival was estimated at 75.0%. Two treatment failures occurred at 5 and 28 months, both in patients with single lesions in the pineal region treated with focal radiotherapy only. Based on the patterns of failure, our outcomes support the continued use of the whole ventricular field vs a focal field, even in patients with limited disease who demonstrate a complete response to neoadjuvant chemotherapy.
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Affiliation(s)
- Peter Paximadis
- Department of Radiation Oncology, Wayne State University and Detroit Medical Center, Detroit, MI 48201, USA.
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Khafaga Y, El Weshi A, Nazmy M, Hassounah M, Alshail E, Moussa E, Allam A, Alkofide A, Jamshed A, ELhusseiny G, Ezzat I, Jenkin D. Intracranial germ cell tumors: a single-institution experience. Ann Saudi Med 2012; 32:359-65. [PMID: 22705605 PMCID: PMC6081024 DOI: 10.5144/0256-4947.2012.359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Intracranial germ cell tumors (GCTs) are not a common disease. We reviewed the experience of a single institution to determine the variables that affect treatment outcome. DESIGN AND SETTING A retrospective review of patients with the diagnosis of intracranial germ cell tumors treated in a single institution (KFSHRC) during the period from March 1985 to December 2007. PATIENTS AND METHODS Fifty-seven patients with the diagnosis of intracranial GCT were recorded in the KFSHRC Tumor Registry during the period from 1985 to 2007. Seven patients with a pineal region tumor treated as germinomas in the earlier years without a tissue diagnosis were excluded. This retrospective study was restricted to the remaining 50 patients with a tissue or marker diagnosis: 31 germinomas and 19 non-germinomatous germ cell tumors (NGGCTs). RESULTS The 10-year overall survival (OS), event-free survival (EFS) and relapse-free survival (RFS) were 87%, 88% and 96% for patients with germinoma, with a median follow-up of 4.5 (range 2-17) years, compared with 26%, 29% and 46% for patients with NGGCT with a median follow-up of 3 (range 1.5-13) years. For NGGCT, variables favorably influencing OS were younger age (< 16 y vs ≥16 y, P=.01), higher radiation dose (>50 Gy vs ≤50 Gy; P=.03) and later year of diagnosis (>1990 vs <1990 P=.002). CONCLUSIONS Tissue diagnosis of GCTs is mandatory prior to treatment except for patients with elevated markers. In germinoma, localized radiotherapy (RT) for M0 patients may be adequate. Long-term follow-up is needed to define the benefit of adding chemotherapy. For NGGCT, the use of combined modality treatment and RT dose ;gt;50 Gy are important factors that influence the outcome. Second-look surgery and resection of residual/ refractory tumors is always recommended.
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Affiliation(s)
- Yasser Khafaga
- Consultant Radiation Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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Kahn L, Fridley J, Patel AJ, Gressot L, Kitagawa R, Goodman JC, Gopinath S. Disseminated germinoma in the brain and cervical spinal cord 10 years after radiographic resolution of pineal germinoma. J Clin Neurosci 2012; 19:1055-7. [PMID: 22551589 DOI: 10.1016/j.jocn.2012.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 01/03/2012] [Indexed: 10/28/2022]
Abstract
Intracranial germinoma, a radiosensitive tumor, is seldom recurrent following initial treatment. When it does recur, it is usually soon after initial treatment and secondary to inadequate radiation field coverage of the tumor. Rarely, there have been case reports of late recurrence many years after initial therapy. Patients with recurrent germinoma in the spine have a less favorable prognosis in terms of treatment response compared to the initial lesion. Thus, careful consideration of the initial lesion, its treatment, and serial imaging of the neural axis with close follow-up is important. We report a patient with a rare delayed recurrence in the brain and cervical spinal cord despite close follow-up with clinical examination and serial imaging.
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Affiliation(s)
- Lora Kahn
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX, USA
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Hanakita S, Takenobu A, Kambe A, Watanabe T, Shin M, Teraoka A. Intramedullary recurrence of germinoma in the spinal cord 15 years after complete remission of a pineal lesion. J Neurosurg Spine 2012; 16:513-5. [PMID: 22360562 DOI: 10.3171/2012.2.spine11499] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present a case of germinoma that was initially found in the pineal region and recurred 15 years later in the intramedullary cervical spinal cord after intensive chemo- and radiotherapy and diagnosis of complete remission. This 28-year-old man initially presented with seizures. Hydrocephalus and a pineal tumor were found on radiological examination, and partial resection of the tumor was performed. Histological diagnosis showed a pure germinoma. Following surgery, the patient received a combination of chemo- and radiotherapy, and a complete remission was shown. However, after 15 years of follow-up, he presented with gait disturbances. Spinal MRI showed an intramedullary mass lesion in the cervical spinal cord. The cervical lesion was biopsied, and histological examination again revealed a pure germinoma. With germinomas, the possibility of a drop metastasis from an intracranial lesion to the spinal cord must be considered during follow-up. However, in the present case, analysis of a CSF sample showed no abnormalities as in previously published cases. In recent years, multidisciplinary treatments have demonstrated good event-free survival rates in cases of pure germinomas, but long-term outcomes over the decades are not fully known. Continual follow-up of such cases is recommended even after complete remission has been achieved.
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Affiliation(s)
- Shunya Hanakita
- Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan.
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Weksberg DC, Shibamoto Y, Paulino AC. Bifocal intracranial germinoma: a retrospective analysis of treatment outcomes in 20 patients and review of the literature. Int J Radiat Oncol Biol Phys 2011; 82:1341-51. [PMID: 21669501 DOI: 10.1016/j.ijrobp.2011.04.033] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 04/01/2011] [Accepted: 04/19/2011] [Indexed: 11/17/2022]
Abstract
PURPOSE Bifocal germinoma (BFG) is a rare intracranial neoplasm for which the choice of radiation therapy (RT) field is controversial. Some believe that BFG represents disseminated disease requiring craniospinal irradiation (CSI), whereas others believe that BFG represents localized disease and advocate for more limited fields. METHODS AND MATERIALS We analyzed 20 BFG patients at our institutions with classic bifocal lesions (pineal gland and suprasellar region). In addition, we identified 60 BFG patients from the literature. The RT fields, use of chemotherapy and extent of disease were recorded and analyzed for each patient. RESULTS There were 55 patients with bifocal lesions only (Group I), and 25 with bifocal lesions plus ventricular and/or CSF positive disease (Group II). The 5-year progression-free survival was 95% for Group I and 80% for Group II. In Group I, there were no failures in patients receiving CSI (n = 11), two spinal failures in those treated with more limited RT fields without chemotherapy (n = 17), and one spinal failure with chemotherapy (n = 23). In Group II, there were no failures in patients receiving CSI (n = 11), but four spinal failures were observed in patients receiving more limited RT fields with chemotherapy (n = 13); 1 patient who received whole-brain RT without chemotherapy experienced failure in the spine and brain. CONCLUSIONS CSI is associated with excellent PFS in BFG. In Group I BFG patients, omission of spinal irradiation appears to be a reasonable approach, especially when chemotherapy is used. Patients with Group II BFG are best treated with CSI.
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Affiliation(s)
- David C Weksberg
- Department of Radiation Oncology, The Methodist Hospital, Houston, TX 77030, USA
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Alapetite C, Brisse H, Patte C, Raquin MA, Gaboriaud G, Carrie C, Habrand JL, Thiesse P, Cuilliere JC, Bernier V, Ben-Hassel M, Frappaz D, Baranzelli MC, Bouffet E. Pattern of relapse and outcome of non-metastatic germinoma patients treated with chemotherapy and limited field radiation: the SFOP experience. Neuro Oncol 2010; 12:1318-25. [PMID: 20716594 DOI: 10.1093/neuonc/noq093] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Over the last two decades, chemotherapy has been introduced in protocols for patients with intracranial germinoma with the objective of reducing the volume and the dose of irradiation without compromising survival rates. The aim of this work is to critically analyze the pattern of relapse in a cohort of patients with nonmetastatic germinoma prospectively treated with chemotherapy followed by focal field radiation. Data of all germinoma patients registered in the French protocol for intracranial germ cell tumors between 1990 and 1999 were reviewed. The pattern of relapse, management, and outcome were analyzed in 10 of 60 patients who developed a recurrence after initial treatment. In 9 patients, the site of recurrence was local or loco-regional, notably in the periventricular area for 8. One patient only had isolated distant leptomeningeal relapse. The review of the sites of relapse suggests that most recurrences could have been avoided with a larger ventricular field of radiation. Treatment at first relapse included chemotherapy (10 patients), high-dose chemotherapy and stem cell transplant (8 patients), and/or radiation therapy (4 patients). Five patients experienced a second relapse. At a median follow-up of 72 months since the first relapse, 8 patients are alive in second or third remission. This review identified an excess of periventricular relapses when the focal field of radiation is used in the combined management of germinoma. These relapses are predominantly marginal or outside radiation fields. Ventricular field radiation appears a logical alternative to decrease the incidence of such relapses. Future trials should aim at better identifying patients who may benefit from local and ventricular radiation, respectively.
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Jensen AW, Laack NNI, Buckner JC, Schomberg PJ, Wetmore CJ, Brown PD. Long-term follow-up of dose-adapted and reduced-field radiotherapy with or without chemotherapy for central nervous system germinoma. Int J Radiat Oncol Biol Phys 2010; 77:1449-56. [PMID: 20045266 DOI: 10.1016/j.ijrobp.2009.06.077] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 06/18/2009] [Accepted: 06/24/2009] [Indexed: 12/24/2022]
Abstract
PURPOSE To update our institutional experience with neoadjuvant chemotherapy and minimized radiotherapy vs. radiation monotherapy for intracranial germinoma. METHODS AND MATERIALS We retrospectively reviewed records of 59 patients with diagnosis of primary intracranial germinoma between 1977 and 2007. Treatment was irradiation alone or neoadjuvant platinum-based chemotherapy and local irradiation (initial tumor plus margin) for patients with localized complete response and reduced-dose craniospinal irradiation for others. RESULTS For the chemoradiotherapy group (n = 28), median follow-up was 7 years. No patient died. The freedom from progression (FFP) rate was 88% at 5 years and 80% at 10 years. In 4 patients, disease recurred 1.1 to 6.8 years after diagnosis. All were young male patients who received 30.6 Gy to local fields after complete response to chemotherapy. The FFP rate was 88% for local irradiation vs. 100% for more extensive fields (p = .06). For the radiotherapy-alone group (n = 31), median follow-up was 15 years. Overall and disease-free survival rates were 93% and 93% at 5 years and 90% and 87% at 15 years. In 5 patients, disease recurred 1.1 to 4.9 years after diagnosis. Most patients in this group were young men 18 to 23 years of age with suprasellar primary disease treated with about 50 Gy to local fields. The FFP rate was 44% for local irradiation vs. 100% for more extensive fields (p < .01). CONCLUSIONS The addition of neoadjuvant chemotherapy to local-field radiotherapy reduced central nervous system cancer recurrence when high-risk patients were excluded by thorough pretreatment staging. There was trend toward improved central nervous system tumor control when larger fields (whole brain, whole ventricle, or craniospinal axis) were used.
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Affiliation(s)
- Ashley W Jensen
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
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