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Brisson RJ, Indelicato DJ, Bradley JA, Aldana PR, Klawinski D, Cassidy V, Morris CG, Mailhot Vega RB. Long-term outcomes following proton therapy for non-metastatic central nervous system germinoma in children and adolescents. Radiother Oncol 2024; 198:110371. [PMID: 38857699 DOI: 10.1016/j.radonc.2024.110371] [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: 03/19/2024] [Revised: 05/20/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND/PURPOSE Radiation is a key component in the treatment of central nervous system pure germinoma (PG) in children and adolescents. Proton therapy (PT) improves normal tissue sparing and potentially reduces adverse effects (AE). The aim of this study was to present the largest single institution experience utilizing PT for the management of PG. MATERIALS METHODS We enrolled 35 non-metastatic patients with PG that were treated with PT at our institution between July 2007 - September 2021. Most received induction chemotherapy (n = 31, 89 %) and whole ventricular irradiation with an involved field boost (n = 29, 83 %). The most common total dose was 30 CGE (n = 18, 51.4 %). We utilized the cumulative incidence method to estimate local control (LC), freedom from distant metastases (FFDM), freedom from progression (FFP), and overall survival (OS). Treatment related toxicity was assessed per CTCAE version 5. RESULTS Median follow-up was 6.2 years (range, 0.9---15.2). The 10-year Kaplan-Meier estimates for LC, FFDM, FFP, and OS were 100 %, 100 %, 100 %, and 94 % respectively. The most common AE were hearing impairment requiring hearing aids (n = 3), transient hypersomnia requiring medication (n = 3), and new onset endocrinopathy (n = 1). Of the 23 evaluable patients ≥ 18 years old at last follow-up, 8 were high school graduates/in college, 8 college graduates, and 7 others gainfully employed. CONCLUSIONS When utilized in modern multimodality treatment of non-metastatic PG, the precise dosimetry of PT does not compromise disease control. Although serious radiation side effects are rare, the 100% cure rate supports further investigation into selective radiation dose and volume de-escalation.
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Affiliation(s)
- Ryan J Brisson
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States.
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Philipp R Aldana
- Department of Neurosurgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL, United States
| | - Darren Klawinski
- Department of Pediatrics, Nemours Children's Specialty Clinic, Jacksonville, FL, United States
| | - Vincent Cassidy
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States
| | - Raymond B Mailhot Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, United States
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Shatara M, Blue M, Stanek J, Liu YA, Prevedello DM, Giglio P, Puduvalli VK, Gardner SL, Allen JC, Wong KK, Nelson MD, Gilles FH, Adams RH, Pauly J, O’Halloran K, Margol AS, Dhall G, Finlay JL. Final report of the phase II NEXT/CNS-GCT-4 trial: GemPOx followed by marrow-ablative chemotherapy for recurrent intracranial germ cell tumors. Neurooncol Pract 2024; 11:188-198. [PMID: 38496907 PMCID: PMC10940828 DOI: 10.1093/nop/npad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Background Patients with relapsed intracranial germinoma can achieve durable remission with standard chemotherapy regimens and/or reirradiation; however, innovative therapies are required for patients with relapsed and/or refractory intracranial nongerminomatous germ cell tumors (NGGCTs) due to their poor prognosis. Improved outcomes have been reported using reinduction chemotherapy to achieve minimal residual disease, followed by marrow-ablative chemotherapy (HDCx) with autologous hematopoietic progenitor cell rescue (AuHPCR). We conducted a phase II trial evaluating the response and toxicity of a 3-drug combination developed for recurrent intracranial germ cell tumors consisting of gemcitabine, paclitaxel, and oxaliplatin (GemPOx). Methods A total of 9 patients with confirmed relapsed or refractory intracranial GCT were enrolled after signing informed consent, and received at least 2 cycles of GemPOx, of which all but 1 had relapsed or refractory NGGCTs. One patient with progressive disease was found to have pathologically confirmed malignant transformation to pure embryonal rhabdomyosarcoma (without GCT elements), hence was ineligible and not included in the analysis. Patients who experienced sufficient responses proceeded to receive HDCx with AuHPCR. Treatment response was determined based on radiographic tumor assessments and tumor markers. Results A total of 7 patients achieved sufficient response and proceeded with HDCx and AuHPCR, and 5 subsequently received additional radiotherapy. A total of 2 patients developed progressive disease while receiving GemPOx. Myelosuppression and transaminitis were the most common treatment-related adverse events. With a mean follow-up of 44 months, 4 patients (3 NGGCTs, 1 germinoma) are alive without evidence of disease. Conclusions GemPOx demonstrates efficacy in facilitating stem cell mobilization, thus facilitating the feasibility of both HDCx and radiotherapy.
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Affiliation(s)
- Margaret Shatara
- Division of Hematology and Oncology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Megan Blue
- Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Joseph Stanek
- Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Yin A Liu
- Departments of Ophthalmology, Neurology, and Neurosurgery, University of California, Davis, Sacramento, California, USA
| | - Daniel M Prevedello
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Pierre Giglio
- Division of Neuro-Oncology, Ohio State University Wexner Medical Center, James Cancer Center, Columbus, Ohio, USA
| | - Vinay K Puduvalli
- Department of Neuro-oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Sharon L Gardner
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, USA
| | - Jeffrey C Allen
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, USA
| | - Kenneth K Wong
- Division of Hematology and Oncology, Cancer and Blood Disease Institute, Children’s Hospital Los Angeles and Keck School of Medicine of University of Southern California, Los Angeles, California, USA
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Marvin D Nelson
- Department of Radiology, Children’s Hospital of Los Angeles, Los Angeles, California, USA
| | - Floyd H Gilles
- Department of Pathology, Children’s Hospital of Los Angeles, Los Angeles, California, USA
| | - Roberta H Adams
- Phoenix Children’s Center for Cancer & Blood Disorders, University of Arizona School of Medicine—Phoenix, and Mayo Clinic, Arizona, USA
| | - Jasmine Pauly
- Division of Hematology and Oncology, Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, California, USA
| | - Katrina O’Halloran
- Division of Hematology and Oncology, Cancer and Blood Disease Institute, Children’s Hospital Los Angeles and Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Ashley S Margol
- Division of Hematology and Oncology, Cancer and Blood Disease Institute, Children’s Hospital Los Angeles and Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Girish Dhall
- Division of Pediatric Hematology/Oncology, Children’s Hospital of Alabama and the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jonathan L Finlay
- Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children’s Hospital and Ohio State University College of Medicine, Columbus, Ohio, USA
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Yeoh TDYY, Nga V, Kimpo M, Lo SS, Vellayappan B. Intracranial Germ Cell Tumors. Semin Neurol 2023; 43:897-908. [PMID: 37963583 DOI: 10.1055/s-0043-1776763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Intracranial germ cell tumors are rare tumors occurring in adolescents and young adults, which include germinomas and non-germinomatous type germ cell tumors (NGGCT). In the past few decades, cooperative trial groups in Europe and North America have developed successful strategies to improve survival outcomes and decrease treatment-related toxicities. New approaches to establishing diagnosis have deferred the need for radical surgery. The 5-year event-free survival (EFS) is above 90% and even patients who present with metastatic germinoma can still be cured with chemotherapy and craniospinal irradiation. The combination of surgery, chemotherapy, and radiation therapy is tailored to patients based on grouping and staging. For NGGCT, neoadjuvant chemotherapy followed by delayed surgery for residual disease and radiotherapy can yield a 5-year EFS of 70%. Further strategies should focus on reducing long-term complications while preserving high cure rates.
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Affiliation(s)
- Teri Danielle You Ying Yeoh
- Department of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore
| | - Vincent Nga
- Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
| | - Miriam Kimpo
- Department of Paediatrics, National University Hospital, Singapore
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington, Seattle, USA
| | - Balamurugan Vellayappan
- Department of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore
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Del Baldo G, Vennarini S, Toniutti M, Abbas R, Lorentini S, Piccirilli E, Cacchione A, Megaro G, Di Ruscio V, De Ioris MA, De Salvo A, Albino G, Rossi S, Colafati GS, Carai A, Mastronuzzi A. Unraveling the impact of upfront chemotherapy and proton beam therapy on treatment outcome and follow-up in central nervous system germ cell tumors: a single center experience. Front Oncol 2023; 13:1259403. [PMID: 37860194 PMCID: PMC10584321 DOI: 10.3389/fonc.2023.1259403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/30/2023] [Indexed: 10/21/2023] Open
Abstract
Background Germ cell tumors (GCT) account for a minority of central nervous system (CNS) malignancies, highly prevalent in adolescents and young adults. Despite their aggressive biological behavior, prognosis is excellent in most cases with risk stratified treatment, consisting in a combination of chemotherapy and radiotherapy. Whole ventricular irradiation (WVI) and craniospinal irradiation, the treatment of choice for localized and metastatic disease, pose significant risk of collateral effects, therefore proton beam radiation (PBT) has been recently proposed for its steep dose fallout. Materials and methods We report our experience in a consecutive series of 17 patients treated for CNS GCT at our Institution from 2015 to 2021. Results Most frequent lesion location were sellar/suprasellar (35%) and bifocal germinoma (35%), followed by pineal (18%) and thalamic (12%). Two patients (12%), had evidence of disseminated disease at the time of diagnosis. At the latest follow-up all but one patient showed complete response to treatment. The only relapse was successfully rescued by additional chemotherapy and PBT. PBT was well tolerated in all cases. No visual, neurological or endocrinological worsening was documented during and after treatment. Neuropsychological evaluation demonstrated preservation of cognitive performance after PBT treatment. Conclusions Our data, albeit preliminary, strongly support the favourable therapeutic profile of PBT for the treatment of CNS germ cell tumors.
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Affiliation(s)
- Giada Del Baldo
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maristella Toniutti
- Department of Medicine DAME-Division of Pediatrics, University of Udine, Udine, Italy
| | - Rachid Abbas
- CESP, INSERM, Université Paris Sud, Villejuif, France
| | - Stefano Lorentini
- Medical Physics Department, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Eleonora Piccirilli
- Department of Diagnostic Imaging Oncological Neuroradiology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti, Chieti, Italy
| | - Antonella Cacchione
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giacomina Megaro
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Valentina Di Ruscio
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Maria Antonietta De Ioris
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Andrea De Salvo
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giulia Albino
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Sabrina Rossi
- Pathology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giovanna Stefania Colafati
- Department of Diagnostic Imaging Oncological Neuroradiology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti, Chieti, Italy
| | - Andrea Carai
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Angela Mastronuzzi
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Ogiwara H, Liao YM, Wong TT. Pineal/germ cell tumors and pineal parenchymal tumors. Childs Nerv Syst 2023; 39:2649-2665. [PMID: 37831207 DOI: 10.1007/s00381-023-06081-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Pineal region tumors (PRTs) are tumors arising from the pineal gland and the paraspinal structures. These tumors are rare and heterogeneous that account for 2.8-10.1% and 0.6-3.2% of tumors in children and in all ages, respectively. Almost all types and subtypes of CNS tumors may be diagnosed in this region. These tumors come from cells of the pineal gland (pinealocytes and neuroglial cells), ectopic primordial germ cells (PGC), and cells from adjacent structures. Hence, PRTs are consisted of pineal parenchyma tumors (PPTs), germ cell tumors (GCTs), neuroepithelial tumors (NETs), other miscellaneous types of tumors, cystic tumors (epidermoid, dermoid), and pineal cyst in addition. The symptoms of PRTs correlate to the increased intracranial cranial pressure due to obstructive hydrocephalus and dorsal midbrain compression. The diagnostic imaging studies are mainly MRI of brain (with and without gadolinium) along with a sagittal view of whole spine. Serum and/or CSF AFP/β-HCG helps to identify GCTs. The treatment of PRTs is consisted of the selection of surgical biopsy/resection, handling of hydrocephalus, neoadjuvant and/or adjuvant therapy according to age, tumor location, histopathological/molecular classification, grading of tumors, staging, and threshold value of markers (for GCTs) in addition. METHODS In this article, we review the following focus points: 1. Background of pineal region tumors. 2. Pineal GCTs and evolution of management. 3. Molecular study for GCTs and pineal parenchymal tumors. 4. Review of surgical approaches to the pineal region. 5. Contribution of endoscopy. 6. Adjuvant therapy (chemotherapy, radiotherapy, and combination). 7. FUTURE DIRECTION RESULTS In all ages, the leading three types of PRTs in western countries were PPTs (22.7-34.8%), GCTs (27.3-34.4%), and NETs (17.2-28%). In children and young adults, the leading PRTs were invariably in the order of GCTs (40-80.5%), PPTs (7.6-21.6%), NETs (2.4-37.5%). Surgical biopsy/resection of PRTs is important for precision diagnosis and therapy. Safe resection with acceptable low mortality and morbidity was achieved after 1970s because of the advancement of surgical approaches, CSF shunt and valve system, microscopic and endoscopic surgery. Following histopathological diagnosis and classification of types and subtypes of PRTs, in PPTs, through molecular profiling, four molecular groups of pineoblastoma (PB) and their oncogenic driver were identified. Hence, molecular stratified precision therapy can be achieved. CONCLUSION Modern endoscopic and microsurgical approaches help to achieve precise histopathological diagnosis and molecular classification of different types and subtypes of pineal region tumors for risk-stratified optimal, effective, and protective therapy. In the future, molecular analysis of biospecimen (CSF and blood) along with AI radiomics on tumor imaging integrating clinical and bioinformation may help for personalized and risk-stratified management of patients with pineal region tumors.
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Affiliation(s)
- Hideki Ogiwara
- Division of Neurosurgery, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, 157-8535, Tokyo, Japan
| | - Yu-Mei Liao
- Division of Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Tai-Tong Wong
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Taipei Medical University Hospital, 252 Wuxing St, Taipei, 11031, Taiwan.
- Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Neuroscience Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
- Pediatric Brain Tumor Program, Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan.
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Abu-Arja MH, Shatara MS, Okcu MF, McGovern SL, Su JM, Abdelbaki MS. The role of neoadjuvant chemotherapy in the management of metastatic central nervous system germinoma: A meta-analysis. Pediatr Blood Cancer 2023; 70:e30601. [PMID: 37501569 DOI: 10.1002/pbc.30601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/20/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND The role of neoadjuvant chemotherapy in treating patients with metastatic central nervous system (CNS) germinoma is controversial. METHODS We compared the relapse-free survival (RFS) of different treatment modalities by performing a meta-analysis using published data. We summarized all data using standard descriptive statistics. We used the Kaplan-Meier method to estimate RFS and their corresponding 95% confidence intervals (CIs). We used the log-rank test for the comparison of survival functions. RESULTS We identified 97 patients with a median age at presentation of 15 years (range: 7-38). Sites of metastasis were cerebrospinal fluid (CSF) disease only (n = 12), brain parenchyma (n = 18), spinal cord (n = 9), ventricular and CSF (n = 10), ventricular only (n = 31), and other (n = 17). The 3-year RFS among patients who received any form of radiotherapy was 89% (95% CI: 83-96) compared with 0% for patients who received a chemotherapy-only regimen (p = .001). Five-year RFS among patients who received craniospinal irradiation (CSI) was 92% (95% CI: 84-100) compared with 76.4% (95% CI: 63-90) in the non-CSI group (with or without neoadjuvant chemotherapy) (p = .014). Five-year RFS of patients who received CSI less than 24 Gy with neoadjuvant chemotherapy was 100% compared with 92% (95% CI: 83-100) CSI dose greater than or equal to 24 Gy alone (p = .3). CONCLUSIONS Our analysis does not support avoiding spinal irradiation among patients with radiographic metastatic CNS germinoma. Future studies are needed to confirm whether neoadjuvant chemotherapy will allow a reduction of irradiation dose without compromising survival.
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Affiliation(s)
- Mohammad H Abu-Arja
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Margaret S Shatara
- Division of Hematology and Oncology, St. Louis Children's Hospital, Washington University, School of Medicine in St. Louis, Washington University, St. Louis, Missouri, USA
| | - M Fatih Okcu
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Susan L McGovern
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jack M Su
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Mohamed S Abdelbaki
- Division of Hematology and Oncology, St. Louis Children's Hospital, Washington University, School of Medicine in St. Louis, Washington University, St. Louis, Missouri, USA
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Malik N, Samples DC, Finneran MM, Graber S, Dorris K, Norris G, Foreman NK, Hankinson TC, Handler MH. Pediatric pineal region masses: a single-center experience over 25 years. Childs Nerv Syst 2023; 39:2307-2316. [PMID: 35831712 DOI: 10.1007/s00381-022-05593-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Pineal region tumors (PRT) represent less than 1% of brain neoplasms. The rare and heterogeneous nature of these tumors is reflected in the variety of treatment modalities employed. METHODS A single-center retrospective review of all pediatric patients with pineal region tumors between November 1996 and June 2021 was performed. Fifty-six cases of pineal tumors were reviewed for age and symptoms upon presentation, diagnostic methods, imaging characteristics, histological classification, treatment modalities, recurrence, and mortality rates. RESULTS The average age at diagnosis was 11.3 years. The majority of patients were male (82.1%) and Caucasian (73.2%). The most common presenting symptoms were headache (n = 38, 67.9%) and visual problems (n = 34, 60.7%). Hydrocephalus was present in 49 patients (87.5%). Germinoma (n = 20, 35.7%) and non-germinomatous germ cell tumor (NGGCT) (n = 17, 30.4%) were the most common tumors. Chemotherapy was employed for 54 patients (96.4%), radiation for 49 (87.5%), and surgical resection for 14 (25.0%). The average duration of treatment was 5.9 months. Progression-free survival was 74.4% at 5 years and 72.0% at 10 years. Overall survival was 85.7% at 5 years and 77.1% at 10 years. CONCLUSION Treatment of pineal region tumors must be targeted to each patient based on presentation, subtype, presence of hydrocephalus, and extent of disease. Upfront surgical resection is usually not indicated. As advances in oncological care proceed, treatment modalities may continue to improve in efficacy.
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Affiliation(s)
- Noor Malik
- Department of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Derek C Samples
- Department of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Megan M Finneran
- Department of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Neurological Surgery, Carle BroMenn Medical Center, Normal, IL, USA
| | - Sarah Graber
- Department of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kathleen Dorris
- Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gregory Norris
- Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicholas K Foreman
- Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Todd C Hankinson
- Department of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael H Handler
- Department of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
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Kremenevski N, Buchfelder M, Hore N. Intracranial Germinomas: Diagnosis, Pathogenesis, Clinical Presentation, and Management. Curr Oncol Rep 2023; 25:765-775. [PMID: 37036624 PMCID: PMC10256636 DOI: 10.1007/s11912-023-01416-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE OF REVIEW Intracranial germinomas constitute a rare brain tumor entity of unknown etiology, characterized by unique histopathology and molecular biology. In this manuscript, we review the literature focusing on the epidemiology, histopathology with molecular biology, clinical presentation with emphasis on tumor location, diagnostic workup, and current treatment strategies with related clinical outcomes of intracranial germinomas. RECENT FINDINGS Although the optimal treatment strategy remains a matter of debate, intracranial germinomas respond well to radiotherapy, chemotherapy, or a combination of both and are characterized by very high cure and survival rates. It is well-known that early discrimination of germinomas from other intracranial neoplasms facilitates the timely initiation of appropriate treatment, thereby contributing to the reduction of morbidity as well as mortality. Ongoing research will need to be directed towards discovering and refining reliable parameters for early diagnosis and evaluation of prognosis in patients with intracranial germinomas.
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Affiliation(s)
- Natalia Kremenevski
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany.
| | - Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Nirjhar Hore
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
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Upadhyayula PS, Neira JA, Miller ML, Bruce JN. Benign and Malignant Tumors of the Pineal Region. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:153-173. [PMID: 37452938 DOI: 10.1007/978-3-031-23705-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Pineal region tumors fall into five broad categories: benign pineal region tumors, glial tumors, papillary tumors, pineal parenchymal tumors, and germ cell tumors. Genetic and transcriptional studies have identified key chromosomal alterations in germinomas (RUNDC3A, ASAH1, LPL) and in pineocytomas/pineoblastomas (DROSHA/DICER1, RB1). Pineal region tumors generally present with symptoms of hydrocephalus including nausea, vomiting, papilledema, and the classical Parinaud's triad of upgaze paralysis, convergence-retraction nystagmus, and light-near pupillary dissociation. Workup requires neuroimaging and tissue diagnosis via biopsy. In germinoma cases, diagnosis may be made based on serum or CSF studies for alpha-fetoprotein or beta-HCG making the preferred treatment radiosurgery, thereby preventing the need for unnecessary surgeries. Treatment generally involves three steps: CSF diversion in cases of hydrocephalus, biopsy through endoscopic or stereotactic methods, and open surgical resection. Multiple surgical approaches are possible for approach to the pineal region. The original approach to the pineal region was the interhemispheric transcallosal first described by Dandy. The most common approach is the supracerebellar infratentorial approach as it utilizes a natural anatomic corridor for access to the pineal region. The paramedian or lateral supracerebellar infratentorial approach is another improvement that uses a similar anatomic corridor but allows for preservation of midline bridging veins; this minimizes the chance for brainstem or cerebellar venous infarction. Determination of the optimal approach relies on tumor characteristics, namely location of deep venous structures to the tumor along with the lateral eccentricity of the tumor. The immediate post-operative period is important as hemorrhage or swelling can cause obstructive hydrocephalus and lead to rapid deterioration. Adjuvant therapy, whether chemotherapy or radiation, is based on tumor pathology. Improvements within pineal surgery will require improved technology for access to the pineal region along with targeted therapies that can effectively treat and prevent recurrence of malignant pineal region tumors.
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Affiliation(s)
| | - Justin A Neira
- Department of Neurological Surgery, Columbia University, New York, USA
| | - Michael L Miller
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Jeffrey N Bruce
- Department of Neurological Surgery, Columbia University, New York, USA.
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Murray MJ, Moleron R, Adamski J, English M, Burke GAA, Cross J, Ajithkumar T, Stoneham S, Nicholson JC. Vinblastine monotherapy induction prior to radiotherapy for patients with intracranial germinoma during the COVID-19 pandemic. Pediatr Blood Cancer 2022; 69:e29359. [PMID: 34520101 PMCID: PMC8662027 DOI: 10.1002/pbc.29359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with localized intracranial germinoma have excellent survival. Reducing treatment burden and long-term sequelae is a priority. Intensive inpatient chemotherapy (e.g., carboPEI = carboplatin/etoposide/ifosfamide) has been effectively employed to reduce radiotherapy treatment volume/dose. Outpatient-based carboplatin monotherapy is associated with excellent outcomes in metastatic testicular seminoma (an identical pathology), and successful vinblastine monotherapy induction (with 77% tumor volume reduction after just two weekly vinblastine doses) has recently been reported in an intracranial germinoma patient. METHODS Adapted UK guidelines for germ cell tumor management were distributed during the COVID-19 pandemic, including nonstandard treatment options to reduce hospital visits and/or admissions. This included vinblastine monotherapy for intracranial germinoma (6 mg/m2 intravenously, or 4 mg/m2 for moderate count suppression, delivered weekly). We describe two such patients treated using this approach. RESULTS A 30-year-old male with a localized pineal tumor received 12-week vinblastine induction, with >60% volume reduction, prior to definitive radiotherapy. A 12-year-old female with a metastatic suprasellar tumor and progression at all sites of disease whilst awaiting proton radiotherapy received two vinblastine doses with good early response, including 36% primary tumor volume reduction. The patients tolerated vinblastine well. CONCLUSION Patients with intracranial germinoma have excellent outcomes, and reduction of late effects remains a priority. The description of vinblastine monotherapy in these intracranial germinoma patients warrants further exploration.
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Affiliation(s)
- Matthew J. Murray
- Department of PathologyUniversity of CambridgeCambridgeUK,Department of Paediatric Haematology and OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Rafael Moleron
- Department of Clinical OncologyAberdeen Royal InfirmaryAberdeenUK
| | - Jennifer Adamski
- Department of Paediatric Haematology and OncologyBirmingham Children's HospitalBirminghamUK
| | - Martin English
- Department of Paediatric Haematology and OncologyBirmingham Children's HospitalBirminghamUK
| | - G. A. Amos Burke
- Department of Paediatric Haematology and OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Justin Cross
- Department of RadiologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Thankamma Ajithkumar
- Department of OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Sara Stoneham
- Department of Paediatric and TYA OncologyUniversity College Hospital LondonLondonUK
| | - James C. Nicholson
- Department of Paediatric Haematology and OncologyCambridge University Hospitals NHS Foundation TrustCambridgeUK
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11
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Venkatasai J, Balakrishnan R, Rajkrishna B, Sebastain P, John RR, Vanjare HA, Prabhu K, Nair B, Mathew LG, Backianathan S. A pragmatic diagnostic approach to primary intracranial germ cell tumors and their treatment outcomes. CNS Oncol 2021; 10:CNS79. [PMID: 34806399 PMCID: PMC8610002 DOI: 10.2217/cns-2021-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/22/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Primary intracranial germ cell tumors (ICGCT) are often diagnosed with tumor markers and imaging, which may avoid the need for a biopsy. An intracranial germ cell tumor with mild elevation of markers is seldom stratified as a distinct entity. Methods: Fifty-nine patients were stratified into three groups: pure germinoma (PG), secreting germinoma (SG) and non-germinomatous germ cell tumors (NGGCTs). Results: At 5 years, progression-free survival and overall survival of the three groups (PG vs SG vs NGGCT) were 91% versus 81% versus 59%, and 100% versus 82% versus 68%, respectively. There was no statistically significant difference in outcome among histologically and clinically diagnosed germinomas. Conclusion: A criterion for clinical diagnosis when a biopsy is not feasible is elucidated, and comparable outcomes were demonstrated with histologically diagnosed germinomas.
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Affiliation(s)
- Jeyaanth Venkatasai
- Department of Radiation Oncology, Dr Ida B Scudder Cancer Center, Christian Medical College, Vellore, 632004, India
- Department of Radiation Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600116, India
| | - Rajesh Balakrishnan
- Department of Radiation Oncology, Dr Ida B Scudder Cancer Center, Christian Medical College, Vellore, 632004, India
| | - Balakrishnan Rajkrishna
- Department of Radiation Oncology, Dr Ida B Scudder Cancer Center, Christian Medical College, Vellore, 632004, India
| | - Patricia Sebastain
- Department of Radiation Oncology, Dr Ida B Scudder Cancer Center, Christian Medical College, Vellore, 632004, India
| | - Rikki Rorima John
- Paediatric Oncology Unit, Department of Child Health, Unit I, Christian Medical College, Vellore, 632004, India
| | | | - Krishna Prabhu
- Department of Neurosurgery, Unit I, Christian Medical College, Vellore, 632004, India
| | - Bijesh Nair
- Department of Neurosurgery, Unit II, Christian Medical College, Vellore, 632004, India
| | - Leni Grace Mathew
- Paediatric Oncology Unit, Department of Child Health, Unit I, Christian Medical College, Vellore, 632004, India
| | - Selvamani Backianathan
- Department of Radiation Oncology, Dr Ida B Scudder Cancer Center, Christian Medical College, Vellore, 632004, India
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12
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Shimizu H, Motomura K, Ohka F, Aoki K, Tanahashi K, Hirano M, Chalise L, Nishikawa T, Yamaguchi J, Yoshida J, Natsume A, Wakabayashi T. Long-term survival in patients with primary intracranial germ cell tumors treated with surgery, platinum-based chemotherapy, and radiotherapy: a single-institution study. J Neurosurg 2021; 135:449-457. [PMID: 33007755 DOI: 10.3171/2020.6.jns20638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The current study aimed to evaluate the treatment outcomes and toxicities of patients with intracranial germ cell tumors (GCTs). METHODS This study retrospectively included 110 consecutive patients (70 patients in the germinomatous group and 40 patients in the nongerminomatous GCT [NGGCT] groups) receiving surgery, platinum-based chemotherapy, and radiotherapy for newly diagnosed primary intracranial GCTs. In the authors' protocol, patients with GCTs were further divided into the following four groups: the germinomatous group and the NGGCT groups (mature teratoma, intermediate prognosis, or poor prognosis). RESULTS The median overall survival (OS) and progression-free survival (PFS) rates of the patients in the germinomatous group were significantly higher than those in the NGGCT group (p < 0.001). The 5-, 10-, and 20-year OS rates in the germinomatous group were 97.1%, 95.7%, and 93.2%, respectively, with a median follow-up of 11.0 years. On the contrary, the 5-, 10-, and 20-year OS rates in the NGGCT group were 67.3%, 63.4%, and 55.4%, respectively. The 5-, 10-, and 20-year PFS rates were 91.4%, 86.6%, and 86.6%, respectively, in the germinomatous group, whereas those of the NGGCT group were approximately 67.4%, 60.2%, and 53.5%, respectively. Based on the four types of classification in our study, the 5-, 10-, and 20-year OS rates in the NGGCT intermediate prognosis group were 78.9%, 71.8%, and 53.8%, respectively. On the contrary, the 3- and 5-year OS rates in the NGGCT poor prognosis group were 42.9% and 34.3%, respectively. Moreover, toxicities with the treatment of intracranial GCTs were found to be tolerable in the present study population. The multivariate survival models for OS in the NGGCT intermediate prognosis and poor prognosis groups demonstrated that only the alpha-fetoprotein status was significantly associated with worsened OS (HR 3.88, 95% CI 1.29-11.66; p = 0.02). CONCLUSIONS The authors found that platinum-based chemotherapy and radiotherapy result in favorable survival outcomes in patients with germinomatous GCTs. Clinical outcomes were still unfavorable in the NGGCT intermediate prognosis and poor prognosis groups; therefore, a new protocol that increases the survival rate of patients belonging in both groups should be considered.
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13
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Molecular Pathology and Targeted Therapies for Personalized Management of Central Nervous System Germinoma. J Pers Med 2021; 11:jpm11070661. [PMID: 34357128 PMCID: PMC8306901 DOI: 10.3390/jpm11070661] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/05/2021] [Accepted: 07/10/2021] [Indexed: 12/19/2022] Open
Abstract
Intracranial germinomas are rare tumours, usually affecting male paediatric patients. They frequently develop in the pineal and suprasellar regions, causing endocrinological disturbances, visual deficits, and increased intracranial pressure. The diagnosis is established on magnetic resonance imaging (MRI), serum and cerebrospinal fluid (CSF) markers, and tumour stereotactic biopsy. Imaging techniques, such as susceptibility-weighted imaging (SWI), T2* (T2-star) gradient echo (GRE) or arterial spin labelling based perfusion-weighted MRI (ASL-PWI) facilitate the diagnosis. Germinomas are highly radiosensitive tumours, with survival rates >90% in the context of chemoradiotherapy. However, patients with resistant disease have limited therapeutic options and poor survival. The aim of this review is to highlight the genetic, epigenetic, and immunologic features, which could provide the basis for targeted therapy. Intracranial germinomas present genetic and epigenetic alterations (chromosomal aberrations, KIT, MAPK and PI3K pathways mutations, DNA hypomethylation, miRNA dysregulation) that may represent targets for therapy. Tyrosine kinase and mTOR inhibitors warrant further investigation in these cases. Immune markers, PD-1 (programmed cell death protein 1) and PD-L1 (programmed death-ligand 1), are expressed in germinomas, representing potential targets for immune checkpoint inhibitors. Resistant cases should benefit from a personalized management: genetic and immunological testing and enrolment in trials evaluating targeted therapies in intracranial germinomas.
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14
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Tso WWY, Hui ESK, Lee TMC, Liu APY, Ip P, Vardhanabhuti V, Cheng KKF, Fong DYT, Chang DHF, Ho FKW, Yip KM, Ku DTL, Cheuk DKL, Luk CW, Shing MK, Leung LK, Khong PL, Chan GCF. Brain Microstructural Changes Associated With Neurocognitive Outcome in Intracranial Germ Cell Tumor Survivors. Front Oncol 2021; 11:573798. [PMID: 34164332 PMCID: PMC8216078 DOI: 10.3389/fonc.2021.573798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background Childhood intracranial germ cell tumor (GCT) survivors are prone to radiotherapy-related neurotoxicity, which can lead to neurocognitive dysfunctions. Diffusion kurtosis imaging (DKI) is a diffusion MRI technique that is sensitive to brain microstructural changes. This study aimed to investigate the association between DKI metrics versus cognitive and functional outcomes of childhood intracranial GCT survivors. Methods DKI was performed on childhood intracranial GCT survivors (n = 20) who had received cranial radiotherapy, and age and gender-matched healthy control subjects (n = 14). Neurocognitive assessment was performed using the Hong Kong Wechsler Intelligence Scales, and functional assessment was performed using the Lansky/Karnofsky performance scales (KPS). Survivors and healthy controls were compared using mixed effects model. Multiple regression analyses were performed to determine the effects of microstructural brain changes of the whole brain as well as the association between IQ and Karnofsky scores and the thereof. Results The mean Intelligence Quotient (IQ) of GCT survivors was 91.7 (95% CI 84.5 – 98.8), which was below the age-specific normative expected mean IQ (P = 0.013). The mean KPS score of GCT survivors was 85.5, which was significantly lower than that of controls (P < 0.001). Cognitive impairments were significantly associated with the presence of microstructural changes in white and grey matter, whereas functional impairments were mostly associated with microstructural changes in white matter. There were significant correlations between IQ versus the mean diffusivity (MD) and mean kurtosis (MK) of specific white matter regions. The IQ scores were negatively correlated with the MD of extensive grey matter regions. Conclusion Our study identified vulnerable brain regions whose microstructural changes in white and grey matter were significantly associated with impaired cognitive and physical functioning in survivors of pediatric intracranial GCT.
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Affiliation(s)
- Winnie Wan Yee Tso
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Edward Sai Kam Hui
- Department of Diagnostic Radiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Tatia Mei Chun Lee
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong.,Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Anthony Pak Yin Liu
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Vince Vardhanabhuti
- Department of Diagnostic Radiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | | | | | - Dorita Hue Fung Chang
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong.,Department of Psychology, The University of Hong Kong, Hong, Kong, Hong Kong
| | - Frederick Ka Wing Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Ka Man Yip
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Dennis Tak Loi Ku
- Department of Oncology, Hong Kong Children's Hospital, Hong Kong, Hong Kong
| | - Daniel Ka Leung Cheuk
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, Hong Kong
| | - Chung Wing Luk
- Department of Oncology, Hong Kong Children's Hospital, Hong Kong, Hong Kong
| | - Ming Kong Shing
- Department of Oncology, Hong Kong Children's Hospital, Hong Kong, Hong Kong
| | - Lok Kan Leung
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Pek Lan Khong
- Department of Diagnostic Radiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Godfrey Chi-Fung Chan
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing (LKS) Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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15
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Kanamori M, Takami H, Suzuki T, Tominaga T, Kurihara J, Tanaka S, Hatazaki S, Nagane M, Matsuda M, Yoshino A, Natsumeda M, Yamaoka M, Kagawa N, Akiyama Y, Fukai J, Negoto T, Shibahara I, Tanaka K, Inoue A, Mase M, Tomita T, Kuga D, Kijima N, Fukami T, Nakahara Y, Natsume A, Yoshimoto K, Keino D, Tokuyama T, Asano K, Ujifuku K, Abe H, Nakada M, Matsuda KI, Arakawa Y, Ikeda N, Narita Y, Shinojima N, Kambe A, Nonaka M, Izumoto S, Kawanishi Y, Kanaya K, Nomura S, Nakajima K, Yamamoto S, Terashima K, Ichimura K, Nishikawa R. Necessity for craniospinal irradiation of germinoma with positive cytology without spinal lesion on MR imaging-A controversy. Neurooncol Adv 2021; 3:vdab086. [PMID: 34355172 PMCID: PMC8331051 DOI: 10.1093/noajnl/vdab086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cerebrospinal fluid (CSF) cytology and spinal MR imaging are routinely performed for staging before treatment of intracranial germinoma. However, the interpretation of the results of CSF cytology poses 2 unresolved clinical questions: (1) Does positive CSF cytology correlate with the presence of spinal lesion before treatment? and (2) Is craniospinal irradiation (CSI) necessary for patients with positive CSF cytology in the absence of spinal lesion? METHODS Multicenter retrospective analyses were performed based on a questionnaire on clinical features, spinal MR imaging finding, results of CSF cytology, treatments, and outcomes which was sent to 86 neurosurgical and 35 pediatrics departments in Japan. Pretreatment frequencies of spinal lesion on MR imaging were compared between the patients with positive and negative cytology. Progression-free survival (PFS) rates were compared between patients with positive CSF cytology without spinal lesion on MR imaging treated with CSI and with whole brain or whole ventricular irradiation (non-CSI). RESULTS A total of 92 germinoma patients from 45 institutes were evaluated by both CSF cytology and spinal MR images, but 26 patients were excluded because of tumor markers, the timing of CSF sampling or incomplete estimation of spinal lesion. Of the remaining 66 germinoma patients, spinal lesions were equally identified in patients with negative CSF cytology and positive cytology (4.9% and 8.0%, respectively). Eleven patients treated with non-CSI had excellent PFS comparable to 11 patients treated with CSI. CONCLUSION CSI is unnecessary for germinoma patients with positive CSF cytology without spinal lesions on MR imaging.
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Affiliation(s)
- Masayuki Kanamori
- Department of Neurosurgery, Tohoku University Graduate School Medicine, Sendai, Miyagi, Japan
| | - Hirokazu Takami
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School Medicine, Sendai, Miyagi, Japan
| | - Jun Kurihara
- Department of Neurosurgery, Saitama Children’s Medical Center, Saitama, Saitama, Japan
| | - Shota Tanaka
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seiji Hatazaki
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Mitaka, Tokyo, Japan
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Atsuo Yoshino
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Manabu Natsumeda
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Niigata, Japan
| | - Masayoshi Yamaoka
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Naoki Kagawa
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yukinori Akiyama
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Junya Fukai
- Department of Neurological Surgery, Wakayama Medical University School of Medicine, Wakayama, Wakayama, Japan
| | - Tetsuya Negoto
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Ichiyo Shibahara
- Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kazuhiro Tanaka
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Akihiro Inoue
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Touon, Ehime, Japan
| | - Mitsuhiro Mase
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Takahiro Tomita
- Department of neurosurgery, University of Toyama, Toyama, Toyama, Japan
| | - Daisuke Kuga
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Noriyuki Kijima
- Department of Neurosurgery, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan
| | - Tadateru Fukami
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yukiko Nakahara
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Saga, Japan
| | - Atsushi Natsume
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Aichi, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Kagoshima, Japan
| | - Dai Keino
- Division of Hematology/Oncology, Kanagawa Children`s Medical Center, Yokohama, Kanagawa, Japan
| | - Tsutomu Tokuyama
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kenichiro Asano
- Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Kenta Ujifuku
- Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Nagasaki, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Fukuoka, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Ken-ichiro Matsuda
- Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Naokado Ikeda
- Department of Neurosurgery and Neuroendovascular Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yoshitaka Narita
- Departments of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Naoki Shinojima
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Kumamoto, Japan
| | - Atsushi Kambe
- Division of Neurosurgery, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
| | - Masahiko Nonaka
- Department of Neurosurgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Shuichi Izumoto
- Department of Neurosurgery, Kindai University Faculty of Medicine, Higashi-Osaka, Osaka, Japan
| | - Yu Kawanishi
- Department of Neurosurgery, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Kohei Kanaya
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Sadahiro Nomura
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan
| | - Kohei Nakajima
- Department of Neurosurgery, Tokushima University School of Medicine, Tokushima, Tokushima, Japan
| | - Shohei Yamamoto
- Department of Pediatrics, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Keita Terashima
- Division of Neuro-Oncology, Children’s Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Koichi Ichimura
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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16
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Callec L, Lardy-Cleaud A, Guerrini-Rousseau L, Alapetite C, Vignon L, Chastagner P, Frappaz D, Faure-Conter C. Relapsing intracranial germ cell tumours warrant retreatment. Eur J Cancer 2020; 136:186-194. [PMID: 32711377 DOI: 10.1016/j.ejca.2020.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 05/19/2020] [Accepted: 06/08/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The optimal therapeutic strategy for relapsing intracranial germ cell tumours (IGCTs) has not been clearly established. METHODS Relapses of IGCTs, occurring from 01/01/1990 to 31/12/2014, were retrieved from the Societe Française d'Oncologie Pediatrique-TGM 90, 92 and GCT 96 protocols, and from the National Childhood Solid Tumour Registry. Refractory IGCTs were excluded. RESULTS Forty-four relapsing IGCTs were identified: 14 were initially treated for histologically proven germinomas (germinoma group), 5 for non-histologically proven germinomas (putative germinoma group) and 25 for non-germinomatous germ cell tumours (NGGCTs) (NGGCT group). In the germinoma group, the 5-year event-free survival (EFS) and overall survival (OS) were 79% (95% confidence interval [CI]: 47-93) and 86% (95% CI: 54-96), respectively. Only one of the 11 patients treated with reirradiation experienced a further relapse. A trend of better EFS was observed for relapses at sites that were not initially involved: 5-year EFS of 100% versus 67% (95% CI: 28-88), p = 0.09. In the putative germinoma group, 4 of 5 patients experienced a further event, leading to 2 deaths. In the NGGCT group, the 5-year EFS and OS were 56% (95% CI: 35-73) and 60% (95% CI: 38-76), respectively. A significant improvement in outcomes after high-dose chemotherapy (HDC) was observed: 5-year OS of 72% (95% CI: 46-87) versus 29% (95% CI: 4-61), p = 0.006. CONCLUSION Relapsing germinomas are highly curable; reirradiation appears to play a key role. Histological proof at initial diagnosis if markers are negative is crucial. Despite inferior outcomes relapsing, NGGCTs can be cured in a significant proportion of cases provided intensive treatment including HDC is applied.
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Affiliation(s)
- Laetitia Callec
- Laetitia Callec, CHU- Hôpitaux de Brabois, Department of Pediatrics, Vandoeuvre les Nancy, France
| | - Audrey Lardy-Cleaud
- Audrey Lardy-Cleaud, Department of Biostatistic, Centre Léon Bérard, Lyon, France
| | - Lea Guerrini-Rousseau
- Lea Guerrini-Rousseau, Department of Pediatric and Adolescents Oncology, Institut Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Claire Alapetite
- Claire Alapetite, Institut Curie, Department of Radiation Oncology, Paris, France
| | - Laure Vignon
- Lucie Vignon, INSERM, Paris-Descartes University, Department of Epidemiology, French National Registry of Childhood Solid Tumour Registry (RNTSE), Villejuif, France
| | - Pascal Chastagner
- Pascal Chastagner, CHU- Hôpitaux de Brabois, Department of Pediatrics, Vandoeuvre les Nancy, France
| | - Didier Frappaz
- Didier Frappaz, Institut d'Hemato-oncologie Pediatrique, Lyon, France
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17
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Worawongsakul R, Sirachainan N, Rojanawatsirivej A, Boongird A, Singhsnaeh A, Swangsilpa T, Dhanachai M, Puataweepong P, Ruangkanchanasetr R, Pakakasama S, Anurathapan U, Songdej D, Pongphitcha P, Khongkhatithum C, Hansasuta A, Thokanit NS, Lusawat A, Yuthagovit S, Thammachantha S, Muangruk D, Hongeng S. Carboplatin-based regimen in pediatric intracranial germ-cell tumors (IC-GCTs): effectiveness and ototoxicity. Neurooncol Pract 2019; 7:202-210. [PMID: 32626588 DOI: 10.1093/nop/npz043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2019] [Indexed: 11/14/2022] Open
Abstract
Background Induction chemotherapy with carboplatin followed by radiotherapy has been used for many years for treating intracranial germ-cell tumors (IC-GCTs) in Thailand. The objective of this study was to assess treatment outcomes, focusing on survival and ototoxicity. Methods The outcomes of all patients with IC-GCT treated at Ramathibodi Hospital and the Prasat Neurological Institute between 2000 and 2017 were reviewed and analyzed, including all patient characteristics and treatment modalities. Five-year overall survival (OS) and event-free survival (EFS) were analyzed using the Kaplan-Meier method, and factors affecting survival were compared using the log-rank test. Results Fifty-three patients age 1-14 years (median, 11 years) were included in this study. The median follow-up time was 63 months. The 5-year EFS and OS rates were 94.3% and 96.2% for all patients, respectively. No statistical difference in OS or EFS was observed between the data of recipients in the carboplatin-based and historical cisplatin-based therapies in our institutes. Concerning radiotherapy, omission of radiotherapy or focal irradiation results in worse long-term survival outcomes, but reduction in dose of radiotherapy to less than 40 Gy did not cause any negative impact on survival rates. Furthermore, carboplatin was associated with lower rates of hearing loss than cisplatin (5.7% vs 87.5%). Conclusions Induction chemotherapy with carboplatin-based regimens was associated with excellent survival rates and low ototoxicity in patients with IC-GCT. Radiotherapy should be given to all patients with a minimal volume equivalent to whole-ventricular radiotherapy, during which doses of lower than 40 Gy can be effectively used.
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Affiliation(s)
- Rasin Worawongsakul
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Nongnuch Sirachainan
- Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | | | - Atthaporn Boongird
- Department of Surgery, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Arunee Singhsnaeh
- Department of Pathology, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Thiti Swangsilpa
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Mantana Dhanachai
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Putipun Puataweepong
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Rawee Ruangkanchanasetr
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Samart Pakakasama
- Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Usanarat Anurathapan
- Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Duantida Songdej
- Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Pongpak Pongphitcha
- Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Chaiyos Khongkhatithum
- Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Ake Hansasuta
- Department of Surgery, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | | | - Apasri Lusawat
- Prasat Neurological Institute, Ratchathewi, Bangkok, Thailand
| | | | | | | | - Suradej Hongeng
- Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
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Abstract
Pediatric central nervous system (CNS) tumors are the most common solid tumors in children and comprise 15% to 20% of all malignancies in children. Presentation, symptoms, and signs depend on tumor location and age of the patient at the time of diagnosis. This article summarizes the common childhood CNS tumors, presentations, classification, and recent updates in treatment approaches due to the increased understanding of the molecular pathogenesis of pediatric brain tumors.
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Affiliation(s)
- Yoko T Udaka
- The Brain Tumor Institute, Center for Neuroscience and Behavioral Medicine, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Division of Oncology, Center for Cancer and Blood Disorders, 111 Michigan Avenue Northwest, Washington, DC 20010, USA
| | - Roger J Packer
- The Brain Tumor Institute, Center for Neuroscience and Behavioral Medicine, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; The Brain Tumor Institute, Gilbert Family Neurofibromatosis Institute, Children's National Medical Center, 111 Michigan Avenue Northwest, Washington, DC 20010, USA.
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19
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Lee DS, Lim DH, Kim IH, Kim JY, Han JW, Yoo KH, Park KD, Park HJ, Chung NG, Suh CO, Kim DS. Upfront chemotherapy followed by response adaptive radiotherapy for intracranial germinoma: Prospective multicenter cohort study. Radiother Oncol 2019; 138:180-186. [PMID: 31319280 DOI: 10.1016/j.radonc.2019.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/21/2019] [Accepted: 06/02/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the efficacy of upfront chemotherapy followed by response-adapted reduced-dose/reduced-volume radiotherapy (RT) for intracranial germinoma. MATERIALS AND METHODS Ninety-one patients from five institutions were registered in the KSPNO G051/G081 Protocol. Germinomas were classified as solitary or multiple/disseminated diseases, and upfront chemotherapy was administered. For all patients with multiple or disseminated disease, and patients with partial response after chemotherapy, 19.5-24 Gy of craniospinal irradiation plus 10.8-19.8 Gy of tumor bed boost were planned. For patients with complete response (CR), reduced-dose RT (30.6 Gy) was planned, along with a reduced field for solitary lesions. RESULTS The median patient age was 14 (range, 3-30) years. Sixty-five patients (71.4%) had a solitary lesion. The median follow-up duration was 67.9 (range, 6.6-119.3) months. Recurrence was not observed in 32 patients in the protocol compliant group. Four patients (4.4%) in the protocol non-compliant group experienced relapse after CR and one patient died of the disease. The 5-year and 7-year overall survival rates were 98.8% and 98.8%, while the corresponding event-free survival rates were 96.6% and 93.8%, respectively. All three patients with basal ganglia germinomas who were treated with local RT experienced recurrence outside the RT field. Among the 23 patients with pineal or suprasellar lesions who received whole-ventricle RT, there was no recurrence. CONCLUSIONS Currently used upfront chemotherapy followed by reduced-dose, reduced-volume RT appears acceptable, when whole-ventricle RT for pineal or suprasellar tumors and, at minimum, whole-brain RT for basal ganglia/thalamus lesions are applied.
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Affiliation(s)
- Dong Soo Lee
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Joo-Young Kim
- Department of Radiation Oncology, National Cancer Center, Goyang, Republic of Korea
| | - Jung Woo Han
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Duk Park
- Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeon Jin Park
- Department of Pediatrics, National Cancer Center, Goyang, Republic of Korea
| | - Nack-Gyun Chung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Dong-Seok Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
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20
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Abu Arja MH, Stalling M, Governale LS, Pierson CR, Rusin JA, Palmer JD, Finlay JL, Olshefski R, Boué DR. Germinoma Involving the Retina: An Unusual Presentation of Recurrent Intracranial Mixed Germ Cell Tumor. World Neurosurg 2019; 124:116-120. [PMID: 30630044 DOI: 10.1016/j.wneu.2018.12.143] [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: 09/25/2018] [Revised: 12/23/2018] [Accepted: 12/26/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND We report a patient with primary central nervous system mixed malignant germ cell tumor (GCT) who presented with recurrent malignant germinomatous infiltration of the retina. CASE DESCRIPTION A ten-year-old girl initially presented with a large suprasellar mixed malignant GCT with a near-complete response after initial induction chemotherapy and irradiation. Three and half years after initial therapy, she presented with progressively worsening vision in her left eye. Magnetic resonance imaging showed infiltrative changes within the left optic nerve but no discrete mass. Serum and cerebrospinal fluid (CSF) tumor markers were not elevated and CSF cytology was negative. Left optic nerve biopsy confirmed the presence of mature teratoma and pure germinoma components. She was treated with gross-total resection of the left eye and optic nerve and chemotherapy. Histopathologic evaluation of the optic nerve showed only mature teratoma elements but with pure germinoma cells infiltrating the inner layers of the retina. CONCLUSIONS Loco-regional extension of suprasellar GCT to the optic nerve is not uncommon; however, infiltration of the tumor into the retina is not reported in the literature. Early detection of optic pathway involvement and proper delineation of the irradiation field may prevent GCT infiltration of the retina with subsequent vision loss.
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Affiliation(s)
- Mohammad H Abu Arja
- The Division of Hematology, Oncology and Blood and Marrow Transplant, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH 43205 USA.
| | - Melissa Stalling
- The Department of Pathology & Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH 43205 and The Department of Pathology, The Ohio State University, College of Medicine, Columbus, OH 43210 USA
| | - Lance S Governale
- Department of Neurosurgery, University of Florida, Gainesville, FL 32611 USA
| | - Christopher R Pierson
- The Department of Pathology & Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH 43205 and The Department of Pathology, The Ohio State University, College of Medicine, Columbus, OH 43210 USA; The Department of Biomedical Education and Anatomy, The Ohio State University, College of Medicine, Columbus, OH 43210 USA
| | - Jerome A Rusin
- The Department of Radiology, Nationwide Children's Hospital, Columbus, OH, 43205 USA
| | - Joshua D Palmer
- The Department of Radiation Oncology, The James Cancer Hospital at The Ohio State University, Columbus, OH, 43210 USA
| | - Jonathan L Finlay
- The Division of Hematology, Oncology and Blood and Marrow Transplant, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH 43205 USA
| | - Randal Olshefski
- The Division of Hematology, Oncology and Blood and Marrow Transplant, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH 43205 USA
| | - Daniel R Boué
- The Department of Pathology & Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH 43205 and The Department of Pathology, The Ohio State University, College of Medicine, Columbus, OH 43210 USA
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21
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Neurocognitive function, performance status, and quality of life in pediatric intracranial germ cell tumor survivors. J Neurooncol 2018; 141:393-401. [DOI: 10.1007/s11060-018-03045-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/02/2018] [Indexed: 02/07/2023]
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22
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Cognitive Profile of Children With Intracranial Germ Cell Tumor According to Tumor Location. J Pediatr Hematol Oncol 2018; 40:e424-e428. [PMID: 29746441 DOI: 10.1097/mph.0000000000001200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the long-term cognitive sequelae and to describe the neuropsychological profile of patients with intracranial germ cell tumors according to tumor location (pineal or suprasellar site). PATIENTS AND METHODS Forty-five children treated at Gustave Roussy between 1991 and 2010 were assessed with neuropsychological tests to measure IQ, memory, visuospatial, motor, and executive skills at a mean delay of 4.2 years after diagnosis. All patients have received chemotherapy associated with surgery in 17 cases. Thirty-nine patients received, radiotherapy (focal 27, focal plus ventricles 8, craniospinal 4). Twenty-three patients had 2 IQ assessments with a mean delay of 4.1 years between the first and second. RESULTS Full scale IQ was preserved, with higher verbal IQ than other IQ indexes. Visuospatial, fine-motor, and executive difficulties were present in a significant proportion of patients. Visuospatial and fine-motor deficits were significantly associated with oculomotor difficulties, more present in the pineal than in the suprasellar group. No cognitive decline was observed between the first and the second IQ assessment. CONCLUSIONS Overall cognitive abilities were preserved in children treated for central nervous system germ cell tumor.
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23
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Bowzyk Al-Naeeb A, Murray M, Horan G, Harris F, Kortmann RD, Nicholson J, Ajithkumar T. Current Management of Intracranial Germ Cell Tumours. Clin Oncol (R Coll Radiol) 2018; 30:204-214. [DOI: 10.1016/j.clon.2018.01.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/25/2017] [Accepted: 12/12/2017] [Indexed: 12/19/2022]
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24
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Fetcko K, Dey M. Primary Central Nervous System Germ Cell Tumors: A Review and Update. MEDICAL RESEARCH ARCHIVES 2018; 6:1719. [PMID: 30271875 PMCID: PMC6157918 DOI: 10.18103/mra.v6i3.1719] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
IMPORTANCE Primary central nervous system (CNS) germ cell tumors (GCT) are a heterogeneous group of tumors that are still poorly understood. In North America, GCTs comprise approximately 1% of primary brain tumors in pediatric and young adult patients. GCTs can occur as pure or mixed subtypes; they are divided into germinomas, which are the most common subtype, and non-germinomatous germ cell tumors (NGGCTs), which consist of approximately one-third of GCTs and include teratomas, embryonal carcinomas, choriocarcinomas, and yolk sac tumors. OBSERVATIONS While the etiology of primary CNS GCT is not entirely clear, the various subtypes are lineage-related and may involve progenitor germ cells that fail to migrate and become trapped in midline locations. Primary CNS GCT most commonly arises in the pineal region but also occur in other areas. Presenting symptoms can include headache, Parinaud syndrome, diabetes insipidus, precosious puberty, ataxia, or hemiparesis. Diagnosis of primary CNS GCTs can be difficult and is often delayed. Various imaging studies and tumor markers can assist in specific diagnosis. Treatment plans differ depending on the subtype of GCT and may vary among physicians and institutions. Germinomas have a favorable prognosis with a greater than 90% overall survival, while NGGCTs only have survival rates ranging from 40-70%. CONCLUSIONS AND RELEVANCE Germinomas seem to be most effectively treated with chemotherapy and radiation, while NGGCT usually require surgical resection, chemotherapy, and radiation with the exception of mature teratomas frequently curable with surgery alone. Gamma knife radiosurgery is a promising treatment that may be an effective additional treatment option. Cytogenic and molecular analyses are attempting to further specify the different GCT subtypes and are helping to direct the development of distinct therapeutic targets to improve treatment and prognosis.
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Affiliation(s)
- Kaleigh Fetcko
- Department of Neurosurgery, Indiana University School of Medicine, IUPUI, Indiana, USA
| | - Mahua Dey
- Department of Neurosurgery, Indiana University School of Medicine, IUPUI, Indiana, USA,Correspondence: Mahua Dey, MD, Indiana University Purdue University Indianapolis (IUPUI), Neuroscience Re-search Building, 320 W 15th Street, NB 400A, Indianapolis, IN 46202; Tel: 317-274-2601;
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25
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Zapotocky M, Ramaswamy V, Lassaletta A, Bouffet E. Adolescents and young adults with brain tumors in the context of molecular advances in neuro-oncology. Pediatr Blood Cancer 2018; 65. [PMID: 29049858 DOI: 10.1002/pbc.26861] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 12/26/2022]
Abstract
Adolescents and young adults (AYA) comprise a specific group of oncology patients with a distinct biological and epidemiological spectrum of central nervous system neoplasms. It has been well documented that they differ clinically, especially in relation to prognosis and chemotherapy tolerance; however, the underlying reasons for this are unclear. Recent advances in the genomics of both childhood and adult brain tumors have provided new explanations and insights into the previously described age-dependent heterogeneity. Herein, we summarize the current state of the AYA population in neuro-oncology, specifically how biological advances can help personalize therapy for this unique group of patients.
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Affiliation(s)
- Michal Zapotocky
- Department of Pediatric Hematology and Oncology, University Hospital Motol and 2nd Medical School, Charles University, Prague, Czech Republic.,Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Vijay Ramaswamy
- Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Alvaro Lassaletta
- Pediatric Hematology Oncology Department, Hospital Niño Jesús, Madrid, Spain
| | - Eric Bouffet
- Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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26
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Murray MJ, Bailey S, Heinemann K, Mann J, Göbel UK, Saran F, Hale JP, Calaminus G, Nicholson JC. Treatment and outcomes of UK and German patients with relapsed intracranial germ cell tumors following uniform first-line therapy. Int J Cancer 2017; 141:621-635. [PMID: 28463397 DOI: 10.1002/ijc.30755] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/06/2017] [Indexed: 01/07/2023]
Abstract
We aimed to retrospectively assess treatments/outcomes, including the value of high-dose-chemotherapy and autologous-stem-cell-rescue (HDC + AuSCR) and re-irradiation, in a large, European patient-cohort with relapsed intracranial germ-cell-tumors (GCTs) receiving uniform first-line therapy, including radiotherapy as standard-of-care. Fifty-eight UK/German patients (48 male/10 female) with relapsed intracranial-GCTs [13 germinoma/45 non-germinomatous GCT (NGGCT)] treated 1996-2010 as per the SIOP-CNS-GCT-96 protocol were evaluated. For germinoma, six patients relapsed with germinoma and five with NGGCT (one palliative, one teratoma patient excluded). Five-year overall-survival (OS) for the whole-group (n = 11) was 55%. Four of six germinoma relapses and two of five relapsing with NGGCT were salvaged; patients were salvaged with either standard-dose-chemotherapy (SDC) and re-irradiation or HDC + AuSCR with/without re-irradiation. Of 45 relapsed NGGCT patients, 13 were excluded (three non-protocol adherence, five teratoma, five palliation). Five-year OS for the remaining 32 relapsed malignant NGGCT patients treated with curative intent was 9% (95%CI: 2-26%). By treatment received, 5-year OS for the 10 patients receiving SDC and 22 patients treated with intention for HDC + AuSCR was 0% (0-0%) and 14% (3-36%), respectively. The three relapsed NGGCT survivors had raised HCG markers alone; two received additional irradiation. Patients with relapsed germinoma had better 5-year OS than those with relapsed NGGCT (55 vs. 9%; p = 0.007). Patients with relapsed germinoma were salvaged both with SDC and re-irradiation or HDC + AuSCR with/without re-irradiation; both represent valid treatment options. Outcomes for malignant relapse following initial diagnosis of NGGCT were exceptionally poor; the few survivors received thiotepa-based HDC + AuSCR, which is a treatment option at first malignant relapse for such patients, with further surgery/irradiation where feasible.
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Affiliation(s)
- Matthew J Murray
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, United Kingdom
| | - Shivani Bailey
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, United Kingdom
| | - Katja Heinemann
- Department of Paediatric Haematology and Oncology, University Children's Hospital, Robert Koch Strasse, Bonn, Germany
| | - Jillian Mann
- Department of Paediatric Haematology and Oncology, Birmingham Children's Hospital, Birmingham, B4 6NH, United Kingdom
| | - Ulrich K Göbel
- German Paediatric Surveillance Unit (ESPED), Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Frank Saran
- Department of Oncology, Royal Marsden Hospital, Sutton, Surrey, SM2 5PT, United Kingdom
| | - Juliet P Hale
- Department of Paediatric Haematology and Oncology, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle upon Tyne, Tyne and Wear, NE1 4LP, United Kingdom
| | - Gabriele Calaminus
- Department of Paediatric Haematology and Oncology, University Children's Hospital, Robert Koch Strasse, Bonn, Germany
| | - James C Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, United Kingdom
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Kreutz J, Potorac I, Lutteri L, Gennigens C, Martin D, Daly AF, Bonneville JF, Tshibanda L, Beckers A. Adipsic diabetes insipidus revealing a bifocal intracranial germinoma. ANNALES D'ENDOCRINOLOGIE 2017; 78:141-145. [PMID: 28483362 DOI: 10.1016/j.ando.2016.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/01/2016] [Accepted: 10/06/2016] [Indexed: 10/19/2022]
Abstract
Adipsic diabetes insipidus is a rare complication of intracranial tumors in which impaired antidiuretic hormone secretion is associated with the loss of thirst sensation. Here, we present the case of a patient with bifocal intracranial germinoma, diagnosed due to symptoms mainly caused by adipsic diabetes insipidus. This is, to our knowledge, the first case of adipsic diabetes insipidus revealing an intracranial germinoma reported in the literature. We describe the diagnostic procedures and the three-year follow-up of this patient. Management of intracranial germ-cell tumors is made complex by the wide range of histological features. Although germinomas have a generally better prognosis than most nongerminomatous tumors, they can have severe or even life-threatening presentations. Adipsic diabetes insipidus is one such severe presentation and its rarity can make it difficult to recognize and manage. Awareness of this potential entity is therefore important for clinical practice.
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Affiliation(s)
- Julie Kreutz
- Department of Radiology, CHU de Liège, University of Liège, Liège, Belgium
| | - Iulia Potorac
- Department of Endocrinology, CHU de Liège, University of Liège, 4000 Liège, Belgium
| | - Laurence Lutteri
- Department of Biology, CHU de Liège, University of Liège, 4000 Liège, Belgium
| | - Christine Gennigens
- Department of Oncology, CHU de Liège, University of Liège, 4000 Liège, Belgium
| | - Didier Martin
- Department of Neurosurgery, CHU de Liège, University of Liège, 4000 Liège, Belgium
| | - Adrian F Daly
- Department of Endocrinology, CHU de Liège, University of Liège, 4000 Liège, Belgium
| | - Jean-Francois Bonneville
- Department of Radiology, CHU de Liège, University of Liège, Liège, Belgium; Department of Endocrinology, CHU de Liège, University of Liège, 4000 Liège, Belgium
| | - Luaba Tshibanda
- Department of Radiology, CHU de Liège, University of Liège, Liège, Belgium
| | - Albert Beckers
- Department of Endocrinology, CHU de Liège, University of Liège, 4000 Liège, Belgium.
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28
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Cormenzana Carpio M, Nehme Álvarez D, Hernández Marqúes C, Pérez Martínez A, Lassaletta Atienza A, Madero López L. Tumores germinales intracraneales: revisión de 21 años. An Pediatr (Barc) 2017; 86:20-27. [DOI: 10.1016/j.anpedi.2016.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 11/16/2022] Open
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30
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Huang X, Zhang R, Mao Y, Zhou LF, Zhang C. Recent advances in molecular biology and treatment strategies for intracranial germ cell tumors. World J Pediatr 2016; 12:275-282. [PMID: 27351562 DOI: 10.1007/s12519-016-0021-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 04/13/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Intracranial germ cell tumors (IGCTs) are a group of rare pediatric brain tumors which include various subtypes. The current understanding of the etiology of the tumors and their optimal management strategies remain controversial. DATA SOURCES The data on IGCTs were collected from articles published in the past 20 years, and the origin and etiology of IGCTs at molecular level as well as the relative roles of varied treatment strategies in different prognosis groups according to Matsutani's classification were reviewed. RESULTS Recent cellular and molecular evidence suggests that IGCTs may arise from the transformation of endogenous brain cells; and findings in the molecular characterization of IGCTs suggest roles of CCND2, RB1, and PRDM14 in the pathogenesis of IGCTs and identify the KIT/RAS and AKT1/mTOR pathways as potential therapeutic targets in future. According to Matsutani's classification of IGCTs, the good prognosis group includes both germinomas and mature teratomas. For germinomas, both radiation alone and reduced-dose radiotherapy in combination with adjuvant chemotherapy are effective, while complete surgical excision is recommended for mature teratomas. In the intermediate prognosis group, immature teratoma has been successfully treated with gamma knife surgery. However, for intermediate prognosis IGCTs other than immature teratomas, gross total resection with adjuvant chemotherapy and radiotherapy or gamma knife surgery may be necessary to achieve cure. In the poor prognosis group, survival outcomes are unsatisfactory, and complete surgical resection combined with more intensive chemotherapy and radiotherapy remains the best available treatment option at this time. CONCLUSIONS IGCTs should be strictly classified according to their pathological categories before administering pathology-specific treatments. Although open microsurgical excision is the traditional surgical strategy for IGCTs, recent publications also support the role of endoscopic surgical options for pineal region IGCTs.
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Affiliation(s)
- Xiang Huang
- Department of Neurosurgery, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China
| | - Rong Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China.
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China
| | - Liang-Fu Zhou
- Department of Neurosurgery, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China
| | - Chao Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, China
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Han JW, Koh KN, Kim JY, Baek HJ, Lee JW, Shim KW, Cho J, Kim DS. Current Trends in Management for Central Nervous System Germ Cell Tumor. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2016. [DOI: 10.15264/cpho.2016.23.1.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jung Woo Han
- Division of Pediatric Hemato-Oncology, Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System
| | - Kyung-Nam Koh
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Ulsan College of Medicine & Asan Medical Center, Seoul
| | - Ji Yoon Kim
- Department of Pediatrics, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu
| | - Hee Jo Baek
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Gwangju
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Kyu-Won Shim
- Department of Pediatric Neurosurgery, Severance Hospital, Yonsei University Health System
| | - Jaeho Cho
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Dong-Seok Kim
- Department of Pediatric Neurosurgery, Severance Hospital, Yonsei University Health System
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Laprie A, Hu Y, Alapetite C, Carrie C, Habrand JL, Bolle S, Bondiau PY, Ducassou A, Huchet A, Bertozzi AI, Perel Y, Moyal É, Balosso J. Paediatric brain tumours: A review of radiotherapy, state of the art and challenges for the future regarding protontherapy and carbontherapy. Cancer Radiother 2015; 19:775-89. [PMID: 26548600 DOI: 10.1016/j.canrad.2015.05.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 05/18/2015] [Accepted: 05/21/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Brain tumours are the most frequent solid tumours in children and the most frequent radiotherapy indications in paediatrics, with frequent late effects: cognitive, osseous, visual, auditory and hormonal. A better protection of healthy tissues by improved beam ballistics, with particle therapy, is expected to decrease significantly late effects without decreasing local control and survival. This article reviews the scientific literature to advocate indications of protontherapy and carbon ion therapy for childhood central nervous system cancer, and estimate the expected therapeutic benefits. MATERIALS AND METHODS A systematic review was performed on paediatric brain tumour treatments using Medline (from 1966 to March of 2014). To be included, clinical trials had to meet the following criteria: age of patients 18 years or younger, treated with radiation, and report of survival. Studies were also selected according to the evidence level. A secondary search of cited references found other studies about cognitive functions, quality of life, the comparison of photon and proton dosimetry showing potential dose escalation and/or sparing of organs at risk with protontherapy; and studies on dosimetric and technical issues related to protontherapy. RESULTS A total of 7051 primary references published were retrieved, among which 40 clinical studies and 60 papers about quality of life, dose distribution and dosimetry were analysed, as well as the ongoing clinical trials. These papers have been summarized and reported in a specific document made available to the participants of a final 1-day workshop. Tumours of the meningeal envelop and bony cranial structures were excluded from the analysis. Protontherapy allows outstanding ballistics to target the tumour area, while substantially decreasing radiation dose to the normal tissues. There are many indications of protontherapy for paediatric brain tumours in curative intent, either for localized treatment of ependymomas, germ-cell tumours, craniopharyngiomas, low-grade gliomas; or panventricular irradiation of pure non-secreting germinoma; or craniospinal irradiation of medulloblastomas and metastatic pure germinomas. Carbon ion therapy is just emerging and may be studied for highly aggressive and radioresistant tumours, as an initial treatment for diffuse brainstem gliomas, and for relapse of high-grade gliomas. CONCLUSION Both protontherapy and carbon ion therapy are promising for paediatric brain tumours. The benefit of decreasing late effects without altering survival has been described for most paediatric brain tumours with protontherapy and is currently assessed in ongoing clinical trials with up-to-date proton devices. Unfortunately, in 2015, only a minority of paediatric patients in France can receive protontherapy due to the lack of equipment.
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Affiliation(s)
- A Laprie
- Université Paul-Sabatier, Toulouse, France; Institut Claudius-Regaud, institut universitaire du cancer de Toulouse (IUCT)-Oncopole, radiation oncology, 1, avenue Irene-Joliot-Curie, 31059 Toulouse, France; Périclès-France-Hadron, Toulouse, France.
| | - Y Hu
- GCS-Étoile-France-Hadron, Lyon, France
| | - C Alapetite
- Institut Curie Paris Orsay (ICPO)-France-Hadron, Orsay, France
| | - C Carrie
- GCS-Étoile-France-Hadron, Lyon, France; Centre Léon-Bérard, Lyon, France
| | - J-L Habrand
- Institut Curie Paris Orsay (ICPO)-France-Hadron, Orsay, France; Université Paris Sud, Orsay, France; Archade-France-Hadron, Caen, France; Centre François-Baclesse, Caen, France; Gustave-Roussy, Villejuif, France
| | - S Bolle
- Institut Curie Paris Orsay (ICPO)-France-Hadron, Orsay, France; Impact-France-Hadron, Nice, France
| | - P-Y Bondiau
- Centre Antoine-Lacassagne, Nice, France; CHU de Bordeaux, Bordeaux, France
| | - A Ducassou
- Institut Claudius-Regaud, institut universitaire du cancer de Toulouse (IUCT)-Oncopole, radiation oncology, 1, avenue Irene-Joliot-Curie, 31059 Toulouse, France; Périclès-France-Hadron, Toulouse, France
| | - A Huchet
- Hôpital des Enfants, Toulouse, France
| | - A-I Bertozzi
- Périclès-France-Hadron, Toulouse, France; Université Grenoble Alpes, Grenoble, France
| | - Y Perel
- Université Grenoble Alpes, Grenoble, France
| | - É Moyal
- Université Paul-Sabatier, Toulouse, France; Institut Claudius-Regaud, institut universitaire du cancer de Toulouse (IUCT)-Oncopole, radiation oncology, 1, avenue Irene-Joliot-Curie, 31059 Toulouse, France; Périclès-France-Hadron, Toulouse, France
| | - J Balosso
- GCS-Étoile-France-Hadron, Lyon, France; CHU de Grenoble, Grenoble, France
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Abstract
PURPOSE OF REVIEW Malignant germ cell tumors in the central nervous system are rare and not well known because they occur mainly in adolescents, an age in which patients are dispersed in adult and pediatric wards. Their biology starts to be unraveled by high-throughput genomics and their treatment is now well defined thanks to international studies, including patients from childhood through adulthood. RECENT FINDINGS Chemotherapy gained definitively a role apart from radiotherapy in order to improve tumor control in secreting neoplasms, but also to decrease the volume or dose of radiation therapy in germinomas. Neurocognitive outcome remains good with some disparities because of tumor location, patients with pineal tumors being less impaired than those with supratentorial malignant germ cell tumors. Alterations in the KIT/RAS as well as in the mTOR/AKT pathways have been frequently reported and could represent interesting opportunities to introduce targeted therapies in these neoplasms. SUMMARY Diagnosis and treatment of malignant germ cell tumor of the brain are now well established within experienced multidisciplinary teams taking care of adolescents and young adults. The prognosis of secreting tumors has not yet reached the excellent results obtained for germinomas but aggressive chemotherapy including high-dose chemotherapy with stem-cell support may contribute to improve their outcome. The role of targeted therapies has yet to be determined in view of the recently described molecular findings.
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Abstract
The following is a general overview of the management of CNS germinomas. Over the last 35 years, CNS germinomas have become one of the pediatric brain tumors with the best outcomes with a greater than 85% overall survival over 5 years. This is in part due to the fact that germinomas are very responsive to chemotherapy and radiation. Some of the major challenges going forward will be to find ways to minimize the adverse effects of our treatments particularly with regard to radiation and to improve the quality of life of patients who develop neurologic, neurocognitive and/or endocrine deficiencies.
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Affiliation(s)
- Diana S Osorio
- Langone Medical Center, New York University, New York, NY, USA.,Nationwide Children's Hospital, Columbus, OH, USA
| | - Jeffrey C Allen
- Langone Medical Center, New York University, New York, NY, USA
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Schoenfeld A, Haas-Kogan DA, Molinaro A, Banerjee A, Nicolaides T, Tihan T, Bollen AW, Gupta N, Mueller S. Pure germinomas of the central nervous system: treatment strategies and outcomes. J Neurooncol 2014; 120:643-9. [PMID: 25189788 DOI: 10.1007/s11060-014-1599-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 08/24/2014] [Indexed: 12/19/2022]
Abstract
To evaluate the role of chemotherapy and radiation therapy in the treatment of pure germinomas of the central nervous system (CNS). We reviewed a historical cohort of 79 patients between the ages of 3-35 years who received definitive treatment for newly diagnosed, pure CNS germinoma between 1985 and 2010 at the University of California, San Francisco (UCSF). Median age at diagnosis was 15 years (interquartile range, IQR 12-20 years) and 61 (77.2 %) patients were male. Median follow-up for the cohort was 111.1 months (IQR 45.7-185.1 months). Five-year PFS rate was 86.4 % (95 % CI 76.1-92.4) and 5 year OS rate was 93.0 % (95 % CI 84.1-97.1). Median PFS was 104.6 months (IQR 41.4-170.1 months). Fourteen patients progressed and 8 died of their disease. Patients who received focal irradiation (XRT) and chemotherapy had a significantly higher rate of progression compared to those who received whole brain irradiation (WBI) or whole ventricle irradiation (WVI). Three of 8 patients had a PR to chemotherapy and received focal XRT progressed whereas only 1 of 9 patients who had a CR to chemotherapy who went on to receive focal XRT progressed. Elevation of hCGβ > 50 mIU/ml was not significantly associated with disease progression (HR 5.64, 95 % CI 0.97-32.7, p = 0.054). Patients treated with WBI or WVI with or without chemotherapy achieve better disease control compared to patients treated with focal XRT + chemotherapy.
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Affiliation(s)
- Adam Schoenfeld
- School of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA
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Faure-Conter C. Tumoral markers in tumors of the pineal region. Neurochirurgie 2014; 61:143-5. [PMID: 24856314 DOI: 10.1016/j.neuchi.2013.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/06/2013] [Accepted: 12/27/2013] [Indexed: 12/16/2022]
Abstract
In cases of pineal tumors, a germ cell tumor should always be suspected. As some of them are secreting tumors, tumoral markers (AFP and/or hGC) are an important part of the diagnostic process. Their positivity either in the serum and/or in the cerebrospinal fluid may lead to an accurate diagnosis, avoiding a potentially dangerous surgical biopsy. Follow-up of tumoral markers is useful during and after treatment in order to monitor response to chemotherapy or a remission status.
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Affiliation(s)
- C Faure-Conter
- Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
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Millard NE, Dunkel IJ. Advances in the Management of Central Nervous System Germ Cell Tumors. Curr Oncol Rep 2014; 16:393. [DOI: 10.1007/s11912-014-0393-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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38
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Kortmann RD. Current concepts and future strategies in the management of intracranial germinoma. Expert Rev Anticancer Ther 2013; 14:105-19. [PMID: 24224870 DOI: 10.1586/14737140.2014.856268] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Radiation therapy is the backbone in the management of intracranial germinoma. In localized disease chemotherapy followed by whole brain irradiation is the present standard providing cure rates in excess of 90%. Craniospinal irradiation alone in metastatic disease provides equally excellent outcome. Chemotherapy is able to convert macroscopic to microscopic disease permitting a dose reduction to the tumor site and possibly the ventricular system and is investigated in prospective trials. Chemotherapy alone cannot replace radiotherapy as sole treatment. Whole-ventricular radiotherapy followed by a boost to tumor site without chemotherapy might be feasible. New treatment technologies such as intensity-modulated radiotherapy or proton therapy permit a dose reduction to non-target brain. Data on functional outcome are conflicting and based on small heterogeneous series only mandating prospective investigations.
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Affiliation(s)
- Rolf-Dieter Kortmann
- Department of Radiation Therapy, University of Leipzig, Stephanstr. 9a, 04103 Leipzig, Germany
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Bromberg JEC, Baumert BG, de Vos F, Gijtenbeek JMM, Kurt E, Westermann AM, Wesseling P. Primary intracranial germ-cell tumors in adults: a practical review. J Neurooncol 2013; 113:175-83. [PMID: 23526409 DOI: 10.1007/s11060-013-1114-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 03/12/2013] [Indexed: 11/28/2022]
Abstract
Primary intracranial germ-cell tumors are rare tumors primarily of adolescence, and literature on this disease in adults is scarce. The available evidence on intracranial germ-cell tumors is reviewed with a focus on adult patients whenever possible, and used to make suggestions for diagnosis and treatment. Diagnostic and treatment algorithms were developed to provide an evidence-based backbone to base treatment on in adult patients with a (suspected) primary intracranial germ-cell tumor.
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Affiliation(s)
- Jacoline E C Bromberg
- Department of Neuro-Oncology, Daniel den Hoed Cancer Center, Erasmus University Medical Center, P O Box 5201, 3008 AE, Rotterdam, The Netherlands.
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Calaminus G, Kortmann R, Worch J, Nicholson JC, Alapetite C, Garrè ML, Patte C, Ricardi U, Saran F, Frappaz D. SIOP CNS GCT 96: final report of outcome of a prospective, multinational nonrandomized trial for children and adults with intracranial germinoma, comparing craniospinal irradiation alone with chemotherapy followed by focal primary site irradiation for patients with localized disease. Neuro Oncol 2013; 15:788-96. [PMID: 23460321 DOI: 10.1093/neuonc/not019] [Citation(s) in RCA: 216] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We conducted a nonrandomized international study for intracranial germinoma that compared chemotherapy followed by local radiotherapy with reduced-dose craniospinal irradiation (CSI) alone, to determine whether the combined treatment regimen produced equivalent outcome and avoided irradiation beyond the primary tumor site(s). METHODS Patients with localized germinoma received either CSI or 2 courses of carboplatin and etoposide alternating with etoposide and ifosfamide, followed by local radiotherapy. Metastatic patients received CSI with focal boosts to primary tumor and metastatic sites, with the option to be preceded with chemotherapy. RESULTS Patients with localized germinoma (n = 190) received either CSI alone (n = 125) or combined therapy (n = 65), demonstrating no differences in 5-year event-free or overall survival, but a difference in progression-free survival (0.97 ± 0.02 vs 0.88 ± 0.04; P = .04). Seven of 65 patients receiving combined treatment experienced relapse (6 with ventricular recurrence outside the primary radiotherapy field), and only 4 of 125 patients treated with CSI alone experienced relapse (all at the primary tumor site). Metastatic patients (n = 45) had 0.98 ± 0.023 event-free and overall survival. CONCLUSIONS Localized germinoma can be treated with reduced dose CSI alone or with chemotherapy and reduced-field radiotherapy. The pattern of relapse suggests inclusion of ventricles in the radiation field. Reduced-dose craniospinal radiation alone is effective in metastatic disease.
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Affiliation(s)
- Gabriele Calaminus
- Department of Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany.
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41
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Carlos Chung KH, Owler BK, Dexter M, Chaseling R. Paediatric germ cell tumours of the central nervous system: Results and experience from a tertiary-referral paediatric institution in Australia. J Clin Neurosci 2013; 20:514-9. [PMID: 23317752 DOI: 10.1016/j.jocn.2012.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 04/03/2012] [Accepted: 04/14/2012] [Indexed: 10/27/2022]
Abstract
A retrospective analysis was conducted on consecutive patients with intracranial germ cell tumours diagnosed and treated from 1 January 1997 to 31 December 2007 to assess and determine demographic factors and treatment outcomes of children with these tumours treated in a major paediatric referral hospital in Australia. In this study, intracranial germ cell tumours represented 4.8% of paediatric brain tumours seen. Of the 21 patients identified, 15 (71.4%) were diagnosed with pure germinoma and six (28.6%) with non-germinomatous germ cell tumours (NGGCT) or mixed tumours. One patient received chemotherapy alone, two patients were treated with radiation alone and the remaining 18 received a combination of chemotherapy and radiotherapy. A total of 33 neurosurgical operations were performed with 15 biopsies via open, endoscopic or transphenoidal means; nine open resections; and nine procedures for hydrocephalus comprising seven third ventriculostomies and two ventriculoperitoneal shunts. For patients with pure germinomas, the 5-year disease-free rate (DFS) was 93.3%, and overall survival (OS) rate was 100% compared to NGGCT or mixed tumours (DFS 50%; OS 50%) (DFS p=0.019, OS p=0.004). The data presented show that pure germinomas carry a favourable prognosis. The data also support that treatment with induction chemotherapy followed by dose-attenuated radiotherapy is an effective alternative with results comparable to historical controls treated with craniospinal irradiation. Although chemoradiotherapy has become the mainstay of treatment in intracranial germ cell tumours, surgery remains integral to the management of this condition. Surgery remains important in establishing the histological diagnosis, as well as in the treatment of hydrocephalus. Furthermore, debulking procedures may be advocated in NGGCT as they are often resistant to chemotherapy.
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Affiliation(s)
- K H Carlos Chung
- T. Y. Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
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McCarthy BJ, Shibui S, Kayama T, Miyaoka E, Narita Y, Murakami M, Matsuda A, Matsuda T, Sobue T, Palis BE, Dolecek TA, Kruchko C, Engelhard HH, Villano JL. Primary CNS germ cell tumors in Japan and the United States: an analysis of 4 tumor registries. Neuro Oncol 2012; 14:1194-200. [PMID: 22869621 DOI: 10.1093/neuonc/nos155] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Intracranial germ cell tumors (GCTs) are relatively rare. Their incidence has been considered to be higher in East Asia than in the United States. This study estimates the incidence of CNS GCTs in Japan and the United States, investigates gender discrepancies in each country, and describes treatment outcomes. Data on primary CNS GCTs from 4 databases were utilized: population-based malignant incidence data from (1) the Japan Cancer Surveillance Research Group (2004-2006; 14 registries), malignant and nonmalignant incidence data from (2) the Surveillance, Epidemiology, and End Results Program (2004-2008; 17 registries), and hospital-based observed survival data from (3) the Brain Tumor Registry of Japan (1984-2000) and (4) the US National Cancer Data Base (1990-2003). Incidence rates per 100 000 for malignant GCTs were not statistically significantly different between Japan (males = 0.143, females = 0.046) and the United States (males = 0.118, females = 0.030). The malignant incidence-rate ratio was higher for pineal GCTs versus nonpineal (ie, the rest of the brain) GCTs in Japan (11.5:1 vs 1.9:1, respectively) and the United States (16.0:1 vs 1.7:1, respectively). In general, 5-year survival estimates were high: over 75% for all GCTs, and over 81% for germinomas, regardless of the type of treatment in either Japan or the United States. The incidence of primary GCTs is similar between Japan and the United States and has the same gender-based patterns by location. High rates of survival were observed in both countries.
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Affiliation(s)
- Bridget J McCarthy
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, 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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Treatment strategies for initially disseminated intracranial germinomas: experiences at a single institute. Childs Nerv Syst 2012; 28:557-63. [PMID: 22246339 DOI: 10.1007/s00381-012-1683-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 01/02/2012] [Indexed: 10/14/2022]
Abstract
PURPOSE Initially disseminated intracranial germinomas (IDIGs) can be observed in pre-adult and adolescent brain tumor patients. However, the disease prognosis is undetermined, and the method of optimal treatment remains controversial. METHODS From January 1990 to January 2011, data on 91 intracranial germinoma patients (≤20 years old) were gathered from the Pediatric Brain Tumor database at Taipei Veterans General Hospital. A total of seven patients with a median age of 17.0 years had IDIGs (lesion sites >2), including IDIGs in the ventricular system or the spinal column. Craniospinal irradiation (CSI) plus a primary or metastatic boost was the mainstay strategy for radiotherapy. Six out of a total of seven patients (85.7%) also received systemic chemotherapy (CHT) after radiotherapy. Survivals rates between IDIGs and patients without dissemination were estimated using the Kaplan-Meier method. RESULTS The median follow-up time for all seven patients was 67.5 months (range, 10.3-142.3 months). None of the IDIG patients experienced a recurrence or mortality after the completion of treatment. The 5- and 10-year disease-free survival (DFS) between IDIG and non-dissemination patients were 100%, 100%, 93.0% and 78.6%, respectively (p = 0.339). The 5- and 10-year overall survival (OS) between IDIGs and non-dissemination cases were 100%, 100%, 93.7% and 89.4%, respectively (p = 0.473). CONCLUSIONS IDIG patients did not show reduced survival compared to non-dissemination patients if optimal radiotherapy and chemotherapy were used together.
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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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46
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Pollack IF. Ataxia resulting from posterior fossa tumors of childhood and other mass lesions. HANDBOOK OF CLINICAL NEUROLOGY 2012; 103:161-173. [PMID: 21827887 DOI: 10.1016/b978-0-444-51892-7.00009-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Ataxia is a common presenting symptom and sequela of treatment in children with posterior fossa tumors, and is the most common focal neurological deficit in the majority of tumor types. Owing to the diversity of histologies among pediatric posterior fossa tumors and the concomitant diversity in tumor biology and prognosis, distinctive management strategies are required for each tumor type. In addition, age-related factors influence the ease of diagnosis and difficulty of management for patients with these tumors. In most modern centers, children with such tumors are treated in cooperative group studies, which are designed to increase the percentage of children who achieve long-term survival as well as their functional outcome.
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Affiliation(s)
- Ian F Pollack
- Department of Neurosurgery, Children's Hospital of Pittsburgh and University of Pittsburgh Cancer Institute Brain Tumor Program, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Bhat S, Yadav SP, Suri V, Patir R, Kurkure P, Kellie S, Sachdeva A. Management of childhood brain tumors: consensus report by the Pediatric Hematology Oncology (PHO) Chapter of Indian Academy of Pediatrics (IAP). Indian J Pediatr 2011; 78:1510-9. [PMID: 21695381 DOI: 10.1007/s12098-011-0421-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 04/06/2011] [Indexed: 11/29/2022]
Abstract
Brain tumors are the second most common childhood tumors and remain the leading cause of cancer related deaths in children. Appropriate diagnosis and management of these tumors are essential to improve survival. There are no clinical practical guidelines available for the management of brain tumors in India. This document is a consensus report prepared after a National Consultation on Pediatric Brain Tumors held in Delhi on 06 Nov 2008. The meeting was attended by eminent experts from all over the country, in the fields of Neurosurgery, Radiation Oncology, Pediatric Oncology, Neuropathology, Diagnostic Imaging, Pediatric Endocrinology and Allied Health Professionals. This article highlights that physicians looking after children with brain tumors should work as part of a multidisciplinary team to improve the survival, quality of life, neuro-cognitive outcomes and standards of care for children with brain tumors. Recommendations for when to suspect, diagnostic workup, initial management, long-term follow up and specific management of individual tumors are outlined.
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Affiliation(s)
- Sunil Bhat
- Pediatric Hematology Oncology and BMT Unit, Sir Ganga Ram Hospital, Delhi, India
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Jackson C, Jallo G, Lim M. Clinical Outcomes after Treatment of Germ Cell Tumors. Neurosurg Clin N Am 2011; 22:385-94, viii. [DOI: 10.1016/j.nec.2011.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Mabbott DJ, Monsalves E, Spiegler BJ, Bartels U, Janzen L, Guger S, Laperriere N, Andrews N, Bouffet E. Longitudinal evaluation of neurocognitive function after treatment for central nervous system germ cell tumors in childhood. Cancer 2011; 117:5402-11. [DOI: 10.1002/cncr.26127] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 01/07/2011] [Accepted: 02/17/2011] [Indexed: 11/07/2022]
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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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