Treatment of primary CNS germinomatous germ cell tumors with chemotherapy prior to reduced dose whole ventricular and local boost irradiation.

Abstract

BACKGROUND:

The purpose of this study was to evaluate a reduced irradiation dose strategy for newly diagnosed primary central nervous system (CNS) germinomas.

METHODS:

Twenty patients with histologically diagnosed localized pure germinoma (n = 19) or germinoma with a mature teratoma component (n = 1) received four cycles of carboplatin and etoposide at 3-week intervals. In 18 patients, chemotherapy was followed by whole ventricular irradiation to 21.6-25.5 Gy with a simultaneous integrated or sequential primary site boost to 30-30.6 Gy. Initial tumor markers for beta-human chorionic gonadotrophin (HCGbeta) and alpha-fetoprotein (AFP) were evaluated in serum and lumbar cerebrospinal fluid (CSF). Endoscopic biopsies were performed in 12 patients and partial resections in the remaining 8 patients at diagnosis. Neurocognitive function was evaluated periodically following treatment.

RESULTS:

Eighteen of 20 patients are without evidence of residual or recurrent tumor. Both relapsing patients were subsequently determined to harbor malignant non-germinomatous germ cell tumor (NGGCT). This retrospective study shows that the Kaplan-Meier estimates of event-free survival (EFS) and overall survival (OS) at 3 years for all 20 patients were 89.5 +/- 7.1% and 100%, respectively. Neurocognitive function was well preserved in all 19 evaluable patients.

CONCLUSION:

Chemotherapy followed by reduced dose whole ventricular and local boost irradiation appears to be effective in patients with localized pure CNS germinoma with evidence of preservation of neurocognitive function.

• Authors: Soumen Khatua, Girish Dhall, Sharon O'Neil, Rima Jubran, Judith G Villablanca, Araz Marachelian, Arti Nastia, Robert Lavey, Arthur J Olch, Ignacio Gonzalez, Floyd Gilles, Marvin Nelson, Ashok Panigrahy, Gordon McComb, Mark Krieger, Jing Fan, Richard Sposto, Jonathan L Finlay
• Journal: Pediatric blood & cancer (Pediatr Blood Cancer) Vol. 55 Issue 1 Pg. 42-6 (Jul 15 2010) ISSN: 1545-5017 [Electronic] United States
• PMID: 20222020 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Chorionic Gonadotropin, beta Subunit, Human
• alpha-Fetoproteins
• Etoposide
• Carboplatin

Topics

• Adolescent
• Adult
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Brain Neoplasms (diagnosis, therapy)
• Carboplatin (adverse effects, therapeutic use)
• Central Nervous System Neoplasms (diagnosis, therapy)
• Child
• Child, Preschool
• Chorionic Gonadotropin, beta Subunit, Human (blood)
• Combined Modality Therapy
• Dose-Response Relationship, Radiation
• Etoposide (adverse effects, therapeutic use)
• Female
• Germinoma (diagnosis, therapy)
• Humans
• Infant
• Magnetic Resonance Imaging
• Male
• Neoplasms, Germ Cell and Embryonal (diagnosis, therapy)
• Retrospective Studies
• Young Adult
• alpha-Fetoproteins (analysis)