Gonadal
germ cell tumors respond favorably to
chemotherapy either at diagnosis or when they recur. Histologically similar
tumors may arise in the CNS usually in the pineal or suprasellar regions. Although
radiation therapy may produce a 5 year disease-free survival in excess of 60% in localized pure
germinoma,
germ cell tumors of other histology tend to recur. We have conducted 14
chemotherapy trials in 8 patients with recurrent CNS
germ cell tumors using 3 different single agent and 2 multi-agent
chemotherapy regimens. The histologic diagnoses of the patients were
germinoma (4),
endodermal sinus tumor (2),
embryonal carcinoma (1), and mixed
tumor -
germinoma plus
choriocarcinoma (1). There were 7 males and 1 female with a median age of 13 years. The primary
tumor arose in the pineal region in 6 and was multicentric in 2. Seven patients had local recurrences and one developed an initial recurrence in the spinal canal. Three patients had CNS
metastases at relapse and 2 had systemic
metastases. Objective responses were documented in 7 of 14 trials (50%). Responses were observed with
cyclophosphamide (80 mg/kg) in 3 of 4 patients for 2+, 3, and 5 mos,
cisplatin (120 mg/m2) in 1 of 2 patients for 2+ mos, and the VAB 6 protocol (
vinblastine,
bleomycin,
cyclophosphamide,
actinomycin-d,
cisplatin) in 3 of 5 patients for 5, 8, and 18 mos. The median duration of response was 5 mos. (2+-18). High doses of single
chemotherapy agents such as
cyclophosphamide and
cisplatin as well as VAB 6 regimen have definite activity in recurrent CNS
germ cell tumors, especially
germinoma. Good palliation may be achieved with
chemotherapy alone with acceptable morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)