Intensive chemotherapy followed by reduced-dose radiotherapy for biopsy-proven CNS germinoma with elevated beta-human chorionic gonadotropin.

Abstract

In this study, 10 patients with biopsy-proven germinoma with a beta-human chorionic gonadotropin (β-HCG) level >50 mIU/ml received intensive chemotherapy followed by reduced-dose radiotherapy (RT) to reduce late effects from RT. CSF β-HCG levels were >200 mIU/ml in five patients. After endoscopic or stereotactic biopsy, four cycles of induction chemotherapy were administered prior to RT. A CEB regimen (carboplatin + etoposide + bleomycin) and a CyEB regimen (cyclophosphamide + etoposide + bleomycin) were alternated. No residual tumor remained after induction chemotherapy in six patients, only cystic lesions were present at the primary tumor site in three, and a small solid residual tumor was observed in the remaining patient; however, all these patients had normal β-HCG levels. If complete response was achieved before initiation of RT, 19.5 Gy craniospinal RT (CSRT) + 10.8 Gy local RT was administered to the tumor bed. If residual lesion was suspected, the dose of RT was selected according to the presence/absence of tumor dissemination at diagnosis (19.5 Gy CSRT + 19.8 Gy local RT for localized tumors and 24.0 Gy CSRT + 16.2 Gy local RT for disseminated tumors). Eight patients, including four patients with a β-HCG level >200 mIU/ml, received 19.5 Gy CSRT. All patients remain disease free at a median follow-up of 58 (range 35-94) months from diagnosis. Our data suggest that pathologically pure germinoma with a significantly elevated β-HCG level might be cured with reduced-dose RT if intensive chemotherapy is provided.

• Authors: Do Hoon Lim, Keon Hee Yoo, Na Hee Lee, Soo Hyun Lee, Ki Woong Sung, Hong Hoe Koo, Ji Hye Kim, Yeon-Lim Suh, Yoo Sook Joung, Hyung Jin Shin
• Journal: Journal of neuro-oncology (J Neurooncol) Vol. 117 Issue 2 Pg. 279-85 (Apr 2014) ISSN: 1573-7373 [Electronic] United States
• PMID: 24488445 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Chorionic Gonadotropin, beta Subunit, Human
• Bleomycin
• Etoposide
• Cyclophosphamide
• Carboplatin

Topics

• Adolescent
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Bleomycin (administration & dosage, adverse effects)
• Brain Neoplasms (therapy)
• Carboplatin (administration & dosage, adverse effects)
• Chemoradiotherapy (methods)
• Child
• Chorionic Gonadotropin, beta Subunit, Human (cerebrospinal fluid)
• Cyclophosphamide (administration & dosage, adverse effects)
• Etoposide (administration & dosage, adverse effects)
• Female
• Germinoma (metabolism, therapy)
• Humans
• Induction Chemotherapy (methods)
• Male
• Radiotherapy Dosage
• Young Adult