Improved Outcome of Central Nervous System Germ Cell Tumors: Implications for the Role of Risk-adapted Intensive Chemotherapy
01 Mar 2010-Journal of Korean Medical Science (Korean Academy of Medical Sciences)-Vol. 25, Iss: 3, pp 458-465
TL;DR: It is suggested that risk-adapted intensive chemotherapy may improve the outcome of patients with malignant CNS-GCTs and should be considered as a first line treatment according to the clinical requirements.
Abstract: To determine the impact of treatment protocols on the outcome of central nervous system germ cell tumors (CNS-GCTs), we reviewed the medical records of 53 patients who received front-line chemotherapy from September 1997 to September 2006. Pure germinoma, normal alpha-fetoprotein level and beta-human chorionic gonadotropin level <50 mIU/mL were regarded as low-risk features and the others as high-risk. Patients from different time periods were divided into 3 groups according to the chemotherapy protocols. Group 1 (n=19) received 4 cycles of chemotherapy comprising cisplatin, etoposide and bleomycin. Group 2 (n=16) and group 3 (n=18) received 4 cycles of chemotherapy with cisplatin, etoposide, cyclophosphamide and vincristine in the former and with carboplatin, etoposide, cyclophosphamide and bleomycin in the latter. In group 2 and group 3, high-risk patients received double doses of cisplatin, carboplatin and cyclophosphamide. Radiotherapy was given after chemotherapy according to the clinical requirements. The event-free survivals of groups 1, 2, and 3 were 67.0%, 93.8%, and 100%, respectively (group 1 vs. 2, P=0.06; group 2 vs. 3, P=0.29; group 1 vs. 3, P=0.02). Our data suggest that risk-adapted intensive chemotherapy may improve the outcome of patients with malignant CNS-GCTs.
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TL;DR: The technology of radiotherapy is progressing, so low side effect and high cure rate may be realized and some problems and standards of radi therapy for intracranial germinoma was more clear.
Abstract: The radiotherapy is an important method in treatment of intracranial germinoma.The intracranial germinoma could be cured by radiotherapy alone,but traditional radiotherapy had more side effects.The technology of radiotherapy is progressing,so low side effect and high cure rate may be realized. Rescently,some large amount and long term researches had been reported,so some problems and standards of radiotherapy for intracranial germinoma was more clear.
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TL;DR: Germinomas have a good prognosis, as over 90% of patients can be effectively treated with radiation therapy, and recent reports suggest that the dose and volume of radiation therapy required for disease control can be lessened with the addition of adjuvant chemotherapy.
Abstract: Intracranial germ cell tumors are a heterogeneous group of lesions which occur in children and adults. Within the classification of intracranial germ cell tumors, there are a variety of different tumor types which carry different prognoses. The diagnosis of an intracranial germ cell tumor usually requires histological information, but a subgroup of tumors will secrete specific tumor markers, including α-fetoprotein and β-human chorionic gonadotropin, which may obviate the need for surgical intervention. The management of intracranial germ cell tumors in both children and adults remains unsettled. Germinomas have a good prognosis, as over 90% of patients can be effectively treated with radiation therapy. The dose and volume of radiation therapy needed for disease control is not well established, and controversy exists concerning the need for whole brain or craniospinal radiation therapy for localized tumors. Germinomas are also chemosensitive and recent reports suggest that the dose and volume of radiation therapy required for disease control can be lessened with the addition of adjuvant chemotherapy. The outcome for patients with nongerminomatous germ cell tumors is less favorable. Radiation therapy alone will result in disease control in 40%-60% of patients. The addition of chemotherapy to radiation therapy may improve the rate of survival. The Oncologist 2000;5:312-320
345 citations
"Improved Outcome of Central Nervous..." refers background in this paper
...However, such classifications have limitations since biopsy-proven germinomas can have nongerminomatous elements among the unbiopsied sites and non-secreting tumors can also have nongerminomatous components such as immature teratoma with less favorable prognosis (16)....
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TL;DR: Chemotherapy-only regimens for CNS GCT, although encouraging, should continue to be used only in the setting of formal clinical trials.
Abstract: PURPOSERadiation therapy for CNS germ cell tumors (GCT) is commonly associated with neurologic sequelae. We designed a therapeutic trial to determine whether irradiation could be avoided.PATIENTS AND METHODSPatients received four cycles of carboplatin, etoposide, and bleomycin. Those with a complete response (CR) received two further cycles; others received two cycles intensified by cyclophosphamide.RESULTSSeventy-one patients were enrolled (45 with germinoma and 26 with nongerminomatous GCT [NGGCT]). Sixty-eight were assessable for response. Thirty-nine of 68 (57%) achieved a CR within four cycles. Of 29 patients with less than a CR, 16 achieved CR with intensified chemotherapy or second surgery. Overall, 55 of 71 (78%) achieved a CR without irradiation. The CR rate was 84% for germinomas and 78% for NGGCT. With a median follow-up duration of 31 months, 28 of 71 patients were alive without relapse or progression. Thirty-five showed tumor recurrence (n = 28) or progression (n = 7) at a median of 13 months...
333 citations
TL;DR: Radiotherapy directed toward the craniospinal axis or tumor site alone at decreased dose levels is effective and further attempts to decrease total doses are justified to reduce the risk of late side effects.
Abstract: PURPOSE: A multicenter prospective trial was conducted (Maligue Keimzelltumoren [MAKEI] 83/86/89) to assess outcome in intracranial germinoma after treatment with radiotherapy alone at reduced doses. PATIENTS AND METHODS: Between 1983 and 1993, 60 patients with histologically (n = 58) or cytologically (n = 2) confirmed germinoma were enrolled onto the study. Patients received radiotherapy alone (craniospinal axis/local boost). In the MAKEI 83/86 study (involving 11 patients), the dose to the craniospinal axis was 36 Gy and the dose to the tumor region was 14 Gy. In the MAKEI 89 study (involving 49 patients), doses were 30 and 15 Gy, respectively. RESULTS: Median patient age was 13 years (range, 6 to 31 years). Complete remission was achieved in all patients. The estimated (Kaplan-Meier) 5-year relapse-free survival rate was 91.0% ± 3.9% at a mean follow-up of 59.5 months (range, 3 to 180 months); the estimated overall survival rate was 93.7% ± 3.6%. Relapse occurred in five patients 10 to 33 months (mean,...
234 citations
"Improved Outcome of Central Nervous..." refers methods in this paper
...In the past, radiation therapy was used as a single modality for the treatment of CNS-GCTs (4-12)....
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TL;DR: Sixty-one patients with midline pineal tumors and 16 patients with suprasellar germinomas were treated with surgical decompression and relatively high-dose radiotherapy of the primary site, and there were no long-term complications.
Abstract: Sixty-one patients with midline pineal tumors and 16 patients with suprasellar germinomas were treated with surgical decompression and relatively high-dose radiotherapy of the primary site Results were excellent, and there were no long-term complications Ten per cent of midline pineal tumors and 37% of suprasellar germinomas metastasized to the cerebral or spinal subarachnoid space within 6 months to 5 years Irradiation of the entire neural axis is recommended for locally extensive tumors, simultaneous pineal and hypothalamic lesions, and all biopsy-proved germinomas The five-year survival rate was 79% for midline pineal tumors and 77% for suprasellar germinomas
208 citations
"Improved Outcome of Central Nervous..." refers methods in this paper
...In the past, radiation therapy was used as a single modality for the treatment of CNS-GCTs (4-12)....
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