Radiotherapy of localised intracranial germinoma: time to sever historical ties?

Abstract

The optimum management of localised intracranial germinoma remains controversial. Cure rates for this rare CNS tumour, which arises mainly in adolescents, exceed 90% at 10 years, and limitation of treatment-related late morbidity is therefore essential. Craniospinal radiotherapy plus boost is perceived to be the gold-standard treatment, but there have been suggestions that reduced-volume radiotherapy could be adequate for cure. We reviewed publications since 1988 to compare patterns of disease relapse and cure rates after craniospinal radiotherapy, reduced-volume irradiation alone (i.e., whole-brain or whole-ventricular irradiation followed by a boost), and focal or localised irradiation alone. The recurrence rate after whole-brain or whole-ventricular radiotherapy plus boost was 7.6% compared with 3.8% after craniospinal radiotherapy, with no predilection for isolated spinal relapses (2.9% vs 1.2%). We challenge the consensus that craniospinal radiotherapy is the best treatment for localised germinomas and conclude that reduced-volume radiotherapy plus boost should replace craniospinal radiotherapy when a radiotherapy-only approach is used.

• Authors: S J Rogers, M A Mosleh-Shirazi, F H Saran
• Journal: The Lancet. Oncology (Lancet Oncol) Vol. 6 Issue 7 Pg. 509-19 (Jul 2005) ISSN: 1470-2045 [Print] England
• PMID: 15992700 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Topics

• Adolescent
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage, adverse effects)
• Brain Neoplasms (radiotherapy)
• Child
• Combined Modality Therapy
• Cranial Irradiation (adverse effects)
• Germinoma (radiotherapy)
• Humans
• Neoplasm Recurrence, Local
• Radiotherapy Dosage
• Spine (radiation effects)