Abstract
Object
A radiation dose of 40–50 Gy is able to produce a cure rate of more than 90% in intracranial pure germinoma. However, many attempts have been made to reduce the dose and volume of radiation without compromising the disease control rate because of the toxicity of irradiation. This retrospective study is intended to provide the physician with an appropriate therapeutic strategy.
Materials and methods
We reviewed a series of 10 recurrent germinomas among 117 germinomas diagnosed histologically or clinically between 1979 and 2002. These patients involved underwent three different treatment modalities; radiation alone (N = 71), chemotherapy alone (N = 9), and combined therapy (N = 37). The 10-year overall and relapse-free survival rates were 97 and 93% in the radiation alone group, 89 and 67% in the chemotherapy alone group, and 92 and 92% in the combined therapy group, respectively. As expected, both radiation therapy and combined therapy were effective in controlling the disease. Tumor recurrence was closely related to the volume of radiation but not to the dose of radiation. If the tumor bed and craniospinal axis were fully covered, the radiation dose might be reduced. Chemotherapy alone showed earlier recurrence and a higher tumor recurrence rate. In the case of combined therapy, chemotherapy was useful in reducing the radiation dose but revealed some toxicity (death of two patients).
Conclusions
The investigation of a possible further dose reduction seems worthwhile. Radiation therapy alone with a dose of less than 40 Gy should be compared with ongoing chemotherapeutic protocols combined with low-dose irradiation.
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References
Aida T, Abe H, Fujieda K et al (1993) Endocrine functions in children with suprasellar germinoma. Neurol Med Chir (Tokyo) 33:152–157
Allen JC, Kim JH, Packer RJ (1987) Neoadjuvant chemotherapy for newly diagnosed germ-cell tumors of the central nervous system. J Neurosurg 67:65–70
Amendola BE, McClatchey K, Amendola MA (1984) Pineal region tumors: analysis of treatment results. Int J Radiat Oncol Biol Phys 10:991–997
Aydin F, Ghatak NR, Radie-Keane K et al (1992) The short-term effect of low-dose radiation on intracranial germinoma. A pathologic study. Cancer 69:2322–2326
Bagshawe KD, Harland S (1976) Immunodiagnosis and monitoring of gonadotrophin-producing metastases in the central nervous system. Cancer 38:112–118
Balmaceda C, Heller G, Rosenblum M et al (1996) Chemotherapy without irradiation-a novel approach for newly diagnosed CNS germ cell tumors: results of an international cooperative trial. The first international central nervous system germ cell tumor study. J Clin Oncol 14:2908–2915
Baranzelli MC, Patte C, Bouffet E et al (1997) Nonmetastatic intracranial germinoma: the experience of the French Society of Pediatric Oncology. Cancer 80:1792–1797
Constine LS, Woolf PD, Cann D et al (1993) Hypothalamic-pituitary dysfunction after radiation for brain tumors. N Engl J Med 328:87–94
Fields JN, Fulling KH, Thomas PR et al (1987) Suprasellar germinoma: radiation therapy. Radiology 164:247–249
Haddock MG, Schild SE, Scheithauer BW et al (1997) Radiation therapy for histologically confirmed primary central nervous system germinoma. Int J Radiat Oncol Biol Phys 38:915–923
Huh SJ, Shin KH, Kim IH et al (1996) Radiotherapy of intracranial germinomas. Radiother Oncol 38:19–23
Inamura T, Nishio S, Ikezaki K et al (1999) Human chorionic gonadotrophin in CSF, not serum, predicts outcome in germinoma. J Neurol Neurosurg Psychiatry 66:654–657
Jenkin D, Berry M, Chan H et al (1990) Pineal region germinomas in childhood treatment considerations. Int J Radiat Oncol Biol Phys 18:541–545
Jenkin RD, Simpson WJ, Keen CW (1978) Pineal and suprasellar germinomas. Results of radiation treatment. J Neurosurg 48:99–107
Kiltie AE, Gattamaneni HR (1995) Survival and quality of life of paediatric intracranial germ cell tumour patients treated at the Christie Hospital, 1972–1993. Med Pediatr Oncol 25:450–456
Kumabe T, Kusaka Y, Jokura H et al (2002) [Recurrence of intracranial germinoma initially treated with chemotherapy only]. No Shinkei Geka 30:935–942
Matsutani M (2001) Combined chemotherapy and radiation therapy for CNS germ cell tumors the Japanese experience. J Neurooncol 54:311–316
Matsutani M, Sano K, Takakura K et al (1997) Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg 86:446–455
Mumperow E, Hartmann M (1992) Spermatic cord beta-human chorionic gonadotropin levels in seminoma and their clinical implications. J Urol 147:1041–1043
Nakajima T, Kumabe T, Jokura H et al (2001) Recurrent germinoma in the optic nerve: report of two cases. Neurosurgery 48:214–217; discussion 217–218
Oka H, Kawano N, Tanaka T et al (1998) Long-term functional outcome of suprasellar germinomas: usefulness and limitations of radiotherapy. J Neurooncol 40:185–190
Rao YT, Medini E, Haselow RE et al (1981) Pineal and ectopic pineal tumors: the role of radiation therapy. Cancer 48:708–713
Sano K, Matsutani M (1981) Pinealoma (Germinoma) treated by direct surgery and postoperative irradiation. A long-term follow-up. Childs Brain 8:81–97
Sawamura Y, de Tribolet N, Ishii N et al (1997) Management of primary intracranial germinomas: diagnostic surgery or radical resection? J Neurosurg 87:262–266
Shibamoto Y, Abe M, Yamashita J et al (1988) Treatment results of intracranial germinoma as a function of the irradiated volume. Int J Radiat Oncol Biol Phys 15:285–290
Shibamoto Y, Sasai K, Kokubo M et al (1999) Salvage radiation therapy for intracranial germinoma recurring after primary chemotherapy. J Neurooncol 44:181–185
Shibamoto Y, Takahashi M, Abe M (1994) Reduction of the radiation dose for intracranial germinoma: a prospective study. Br J Cancer 70:984–989
Shibamoto Y, Takahashi M, Sasai K (1997) Prognosis of intracranial germinoma with syncytiotrophoblastic giant cells treated by radiation therapy. Int J Radiat Oncol Biol Phys 37:505–510
Shirato H, Nishio M, Sawamura Y et al (1997) Analysis of long-term treatment of intracranial germinoma. Int J Radiat Oncol Biol Phys 37:511–515
Sugiyama K, Uozumi T, Arita K et al (1994) Clinical evaluation of 33 patients with histologically verified germinoma. Surg Neurol 42:200–210
Sung DI, Harisliadis L, Chang CH (1978) Midline pineal tumors and suprasellar germinomas: highly curable by irradiation. Radiology 128:745–751
Sutton LN, Radcliffe J, Goldwein JW et al (1999) Quality of life of adult survivors of germinomas treated with craniospinal irradiation. Neurosurgery 45:1292–1297; discussion 1297–1298
Ueki K, Tanaka R (1980) Treatments and prognoses of pineal tumors-experience of 110 cases. Neurol Med Chir (Tokyo) 20:1–26
Utsuki S, Kawano N, Oka H et al (1999) Cerebral germinoma with syncytiotrophoblastic giant cells: feasibility of predicting prognosis using the serum hCG level. Acta Neurochir (Wien) 141:975–977; discussion 977–978
Wara WM, Jenkin RD, Evans A et al (1979) Tumors of the pineal and suprasellar region: Children’s Cancer Study Group treatment results 1960–1975: a report from Children’s Cancer Study Group. Cancer 43:698–701
Weissbach L, Bussar-Maatz R (1993) HCG-positive seminoma. Eur Urol 23(Suppl 2):29–32
Wolden SL, Wara WM, Larson DA et al (1995) Radiation therapy for primary intracranial germ-cell tumors. Int J Radiat Oncol Biol Phys 32:943–949
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Funding This study was financially supported by the Ministry of Health and the Welfare (7–2005–1216).
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Shim, KW., Kim, TG., Suh, CO. et al. Treatment failure in intracranial primary germinomas. Childs Nerv Syst 23, 1155–1161 (2007). https://doi.org/10.1007/s00381-007-0394-6
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DOI: https://doi.org/10.1007/s00381-007-0394-6