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Child's Nervous System

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01-02-2013 | Original Paper

Treatment strategy for intracranial primary pure germinoma

Authors: Kyu-Won Shim, Eun Kyung Park, Yoon-Ho Lee, Chang-Ok Suh, Jaeho Cho, Joong-Uhn Choi, Dong-Seok Kim

Published in: Child's Nervous System | Issue 2/2013

Abstract

Object

This prospective randomized clinical study will address the efficacy of radiation (RT)-alone and combined with pre-RT chemotherapy (CTX) treatments and propose the novel standard treatment strategy for intracranial primary pure germinoma.

Materials and methods

Between 2005 and 2008, there were 54 patients diagnosed with intracranial primary pure germinomas in a single institute. Twenty-eight patients were enrolled. The mean age of the patients was 16.2 years (range 6–31 years). There were 19 men and 9 women (men/women ratio = 2.1:1). There were 21 patients with solitary tumors and 7 with multiple tumors. These patients were randomized as RT-only treatment group (11 solitary and 3 multiple tumors) and combined (10 solitary and 4 multiple tumors, neo-adjuvant CTX followed by response-adapted RT) treatment group. The follow-up period for RT only group has a median of 58 months (mean 58.2 months, range 41–82 months), and for combine therapy group, the median was 68.5 months (mean 67.8 months, range 41–88 months). All 14 patients in the RT-only group showed complete response (CR) and no recurrence. Eleven patients in the combined group had CR and three patients had partial response after neo-adjuvant CTX. All patients responded to RT as CR without recurrence. At the time of analysis, all 28 patients were alive without evidence of disease.

Conclusion

Neo-adjuvant CTX for localized germinomas seems to be unnecessary as a method to reduce radiation dose in our RT protocol. However, the effective control of multifocal or disseminated germinoma can be achieved by neo-adjuvant CTX followed by response-adapted reduced dose RT.

Abay EO 2nd, Laws ER Jr, Grado GL, Bruckman JE, Forbes GS, Gomez MR, Scott M (1981) Pineal tumors in children and adolescents. Treatment by CSF shunting and radiotherapy. J Neurosurg 55(6):889–895PubMedCrossRef

Allen JC (1987) Management of primary intracranial germ cell tumors of childhood. Pediatr Neurosci 13(3):152–157PubMedCrossRef

Allen JC, Kim JH, Packer RJ (1987) Neoadjuvant chemotherapy for newly diagnosed germ-cell tumors of the central nervous system. J Neurosurg 67(1):65–70PubMedCrossRef

Allen JC, DaRosso RC, Donahue B, Nirenberg A (1994) A phase II trial of preirradiation carboplatin in newly diagnosed germinoma of the central nervous system. Cancer 74(3):940–944PubMedCrossRef

Amendola BE, McClatchey K, Amendola MA (1984) Pineal region tumors: analysis of treatment results. Int J Radiat Oncol Biol Phys 10(7):991–997PubMedCrossRef

Aydin F, Ghatak NR, Radie-Keane K, Kinard J, Land SD (1992) The short-term effect of low-dose radiation on intracranial germinoma. A pathologic study. Cancer 69(9):2322–2326PubMedCrossRef

Bagshawe KD, Harland S (1976) Immunodiagnosis and monitoring of gonadotrophin-producing metastases in the central nervous system. Cancer 38(1):112–118PubMedCrossRef

Balmaceda C, Heller G, Rosenblum M, Diez B, Villablanca JG, Kellie S, Maher P, Vlamis V, Walker RW, Leibel S, Finlay JL (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(11):2908–2915PubMed

Bamberg M, Kortmann RD, Calaminus G, Becker G, Meisner C, Harms D, Gobel U (1999) Radiation therapy for intracranial germinoma: results of the German cooperative prospective trials MAKEI 83/86/89. J Clin Oncol 17(8):2585–2592PubMed

10.

Buckner JC, Peethambaram PP, Smithson WA, Groover RV, Schomberg PJ, Kimmel DW, Raffel C, O’Fallon JR, Neglia J, Shaw EG (1999) Phase II trial of primary chemotherapy followed by reduced-dose radiation for CNS germ cell tumors. J Clin Oncol 17(3):933–940PubMed

11.

Chang SKSC, Kim GE (1999) Radiation therapy of intracranial germinomas: optimum radiation dose and treatment volume. J Korean Soc Ther Radiol Oncol 17:269–274

12.

Chao CK, Lee ST, Lin FJ, Tang SG, Leung WM (1993) A multivariate analysis of prognostic factors in management of pineal tumor. Int J Radiat Oncol Biol Phys 27(5):1185–1191PubMedCrossRef

13.

Cho J, Choi JU, Kim DS, Suh CO (2009) Low-dose craniospinal irradiation as a definitive treatment for intracranial germinoma. Radiother Oncol 91(1):75–79PubMedCrossRef

14.

Choi UK, Cha SH, Song GS, Choi CH, Lee SW, Lim YT, Kim WT (2007) Recurrent intracranial germinoma along the endoscopic ventriculostomy tract. Case report. J Neurosurg 107(1 Suppl):62–65PubMed

15.

da Silva NS, Cappellano AM, Diez B, Cavalheiro S, Gardner S, Wisoff J, Kellie S, Parker R, Garvin J, Finlay J (2010) Primary chemotherapy for intracranial germ cell tumors: results of the third international CNS germ cell tumor study. Pediatr Blood Cancer 54(3):377–383PubMedCrossRef

16.

Dattoli MJ, Newall J (1990) Radiation therapy for intracranial germinoma: the case for limited volume treatment. Int J Radiat Oncol Biol Phys 19(2):429–433PubMedCrossRef

17.

Dearnaley DP, A’Hern RP, Whittaker S, Bloom HJ (1990) Pineal and CNS germ cell tumors: Royal Marsden Hospital experience 1962–1987. Int J Radiat Oncol Biol Phys 18(4):773–781PubMedCrossRef

18.

Eom KY, Kim IH, Park CI, Kim HJ, Kim JH, Kim K, Kim SK, Wang KC, Cho BG, Jung HW, Heo DS, Kang HJ, Shin HY, Ahn HS (2008) Upfront chemotherapy and involved-field radiotherapy results in more relapses than extended radiotherapy for intracranial germinomas: modification in radiotherapy volume might be needed. Int J Radiat Oncol Biol Phys 71(3):667–671PubMedCrossRef

19.

Farng KT, Chang KP, Wong TT, Guo WY, Ho DM, Hu WL (1999) Pediatric intracranial germinoma treated with chemotherapy alone. Zhonghua Yi Xue Za Zhi (Taipei) 62(12):859–866

20.

Fields JN, Fulling KH, Thomas PR, Marks JE (1987) Suprasellar germinoma: radiation therapy. Radiology 164(1):247–249PubMed

21.

Fouladi M, Grant R, Baruchel S, Chan H, Malkin D, Weitzman S, Greenberg ML (1998) Comparison of survival outcomes in patients with intracranial germinomas treated with radiation alone versus reduced-dose radiation and chemotherapy. Childs Nerv Syst 14(10):596–601PubMedCrossRef

22.

Fuller BG, Kapp DS, Cox R (1994) Radiation therapy of pineal region tumors: 25 new cases and a review of 208 previously reported cases. Int J Radiat Oncol Biol Phys 28(1):229–245PubMedCrossRef

23.

Griffin BR, Griffin TW, Tong DY, Russell AH, Kurtz J, Laramore GE, Groudine M (1981) Pineal region tumors: results of radiation therapy and indications for elective spinal irradiation. Int J Radiat Oncol Biol Phys 7(5):605–608PubMedCrossRef

24.

Haas-Kogan DA, Missett BT, Wara WM, Donaldson SS, Lamborn KR, Prados MD, Fisher PG, Huhn SL, Fisch BM, Berger MS, Le QT (2003) Radiation therapy for intracranial germ cell tumors. Int J Radiat Oncol Biol Phys 56(2):511–518PubMedCrossRef

25.

Haddock MG, Schild SE, Scheithauer BW, Schomberg PJ (1997) Radiation therapy for histologically confirmed primary central nervous system germinoma. Int J Radiat Oncol Biol Phys 38(5):915–923PubMedCrossRef

26.

Hardenbergh PH, Golden J, Billet A, Scott RM, Shrieve DC, Silver B, Loeffler JS, Tarbell NJ (1997) Intracranial germinoma: the case for lower dose radiation therapy. Int J Radiat Oncol Biol Phys 39(2):419–426PubMedCrossRef

27.

Hoffman HJ, Otsubo H, Hendrick EB, Humphreys RP, Drake JM, Becker LE, Greenberg M, Jenkin D (1991) Intracranial germ-cell tumors in children. J Neurosurg 74(4):545–551PubMedCrossRef

28.

Huh SJ, Shin KH, Kim IH, Ahn YC, Ha SW, Park CI (1996) Radiotherapy of intracranial germinomas. Radiother Oncol 38(1):19–23PubMedCrossRef

29.

Jenkin RD, Simpson WJ, Keen CW (1978) Pineal and suprasellar germinomas. Results of radiation treatment. J Neurosurg 48(1):99–107PubMedCrossRef

30.

Jenkin D, Berry M, Chan H, Greenberg M, Hendrick B, Hoffman H, Humphreys R, Sonley M, Weitzman S (1990) Pineal region germinomas in childhood treatment considerations. Int J Radiat Oncol Biol Phys 18(3):541–545PubMedCrossRef

31.

Kersh CR, Constable WC, Eisert DR, Spaulding CA, Hahn SS, Jenrette JM 3rd, Marks RD Jr (1988) Primary central nervous system germ cell tumors. Effect of histologic confirmation on radiotherapy. Cancer 61(11):2148–2152PubMedCrossRef

32.

Khatua S, Dhall G, O’Neil S, Jubran R, Villablanca JG, Marachelian A, Nastia A, Lavey R, Olch AJ, Gonzalez I, Gilles F, Nelson M, Panigrahy A, McComb G, Krieger M, Fan J, Sposto R, Finlay JL (2010) Treatment of primary CNS germinomatous germ cell tumors with chemotherapy prior to reduced dose whole ventricular and local boost irradiation. Pediatr Blood Cancer 55(1):42–46. doi:10.1002/pbc.22468 PubMed

33.

Kumabe T, Kusaka Y, Jokura H, Ikeda H, Shirane R, Yoshimoto T (2002) Recurrence of intracranial germinoma initially treated with chemotherapy only. No Shinkei Geka 30(9):935–942PubMed

34.

Legido A, Packer RJ, Sutton LN, D’Angio G, Rorke LB, Bruce DA, Schut L (1989) Suprasellar germinomas in childhood. A reappraisal. Cancer 63(2):340–344PubMedCrossRef

35.

Linstadt D, Wara WM, Edwards MS, Hudgins RJ, Sheline GE (1988) Radiotherapy of primary intracranial germinomas: the case against routine craniospinal irradiation. Int J Radiat Oncol Biol Phys 15(2):291–297PubMedCrossRef

36.

Maity A, Shu HK, Janss A, Belasco JB, Rorke L, Phillips PC, Sutton LN, Goldwein JW (2004) Craniospinal radiation in the treatment of biopsy-proven intracranial germinomas: twenty-five years’ experience in a single center. Int J Radiat Oncol Biol Phys 58(4):1165–1170PubMedCrossRef

37.

Merchant TE, Davis BJ, Sheldon JM, Leibel SA (1998) Radiation therapy for relapsed CNS germinoma after primary chemotherapy. J Clin Oncol 16(1):204–209PubMed

38.

Merchant TE, Sherwood SH, Mulhern RK, Rose SR, Thompson SJ, Sanford RA, Kun LE (2000) CNS germinoma: disease control and long-term functional outcome for 12 children treated with craniospinal irradiation. Int J Radiat Oncol Biol Phys 46(5):1171–1176PubMedCrossRef

39.

Mumperow E, Hartmann M (1992) Spermatic cord beta-human chorionic gonadotropin levels in seminoma and their clinical implications. J Urol 147(4):1041–1043PubMed

40.

Nakajima T, Kumabe T, Jokura H, Yoshimoto T (2001) Recurrent germinoma in the optic nerve: report of two cases. Neurosurgery 48(1):214–217, discussion 217–218PubMed

41.

Nakamura H, Takeshima H, Makino K, Kuratsu J (2007) Evaluation of residual tissues after adjuvant therapy in germ cell tumors. Pediatr Neurosurg 43(2):82–91PubMedCrossRef

42.

Nguyen QN, Chang EL, Allen PK, Maor MH, Ater JL, Mahajan A, Wolff JE, Weinberg JS, Woo SY (2006) Focal and craniospinal irradiation for patients with intracranial germinoma and patterns of failure. Cancer 107(9):2228–2236PubMedCrossRef

43.

Nho YJCH, Choi EK, Kim JH (1997) Radiation therapy of intracranial germinoma. J Korean Soc Ther Radiol Oncol 15:207–213

44.

Ogawa K, Toita T, Nakamura K, Uno T, Onishi H, Itami J, Shikama N, Saeki N, Yoshii Y, Murayama S (2003) Treatment and prognosis of patients with intracranial nongerminomatous malignant germ cell tumors: a multiinstitutional retrospective analysis of 41 patients. Cancer 98(2):369–376PubMedCrossRef

45.

Oka H, Kawano N, Tanaka T, Utsuki S, Kobayashi I, Maezawa H, Fujii K (1998) Long-term functional outcome of suprasellar germinomas: usefulness and limitations of radiotherapy. J Neurooncol 40(2):185–190PubMedCrossRef

46.

Rich TA, Cassady JR, Strand RD, Winston KR (1985) Radiation therapy for pineal and suprasellar germ cell tumors. Cancer 55(5):932–940PubMedCrossRef

47.

Rogers SJ, Mosleh-Shirazi MA, Saran FH (2005) Radiotherapy of localised intracranial germinoma: time to sever historical ties? Lancet Oncol 6(7):509–519PubMedCrossRef

48.

Sakai N, Yamada H, Andoh T, Hirata T, Shimizu K, Shinoda J (1988) Primary intracranial germ-cell tumors. A retrospective analysis with special reference to long-term results of treatment and the behavior of rare types of tumors. Acta Oncol 27(1):43–50PubMedCrossRef

49.

Salazar OM, Castro-Vita H, Bakos RS, Feldstein ML, Keller B, Rubin P (1979) Radiation therapy for tumors of the pineal region. Int J Radiat Oncol Biol Phys 5(4):491–499PubMedCrossRef

50.

Sano K, Matsutani M (1981) Pinealoma (germinoma) treated by direct surgery and postoperative irradiation. A long-term follow-up. Childs Brain 8(2):81–97PubMed

51.

Sawamura Y, de Tribolet N, Ishii N, Abe H (1997) Management of primary intracranial germinomas: diagnostic surgery or radical resection? J Neurosurg 87(2):262–266PubMedCrossRef

52.

Schoenfeld GO, Amdur RJ, Schmalfuss IM, Morris CG, Keole SR, Mendenhall WM, Marcus RB Jr (2006) Low-dose prophylactic craniospinal radiotherapy for intracranial germinoma. Int J Radiat Oncol Biol Phys 65(2):481–485PubMedCrossRef

53.

Shapiro WR (1986) Therapy of adult malignant brain tumors: what have the clinical trials taught us? Semin Oncol 13(1):38–45PubMed

54.

Shibamoto Y, Abe M, Yamashita J, Takahashi M, Hiraoka M, Ono K, Tsutsui K (1988) Treatment results of intracranial germinoma as a function of the irradiated volume. Int J Radiat Oncol Biol Phys 15(2):285–290PubMedCrossRef

55.

Shibamoto Y, Takahashi M, Abe M (1994) Reduction of the radiation dose for intracranial germinoma: a prospective study. Br J Cancer 70(5):984–989PubMedCrossRef

56.

Shibamoto Y, Sasai K, Kokubo M, Hiraoka M (1999) Salvage radiation therapy for intracranial germinoma recurring after primary chemotherapy. J Neurooncol 44(2):181–185PubMedCrossRef

57.

Shikama N, Ogawa K, Tanaka S, Toita T, Nakamura K, Uno T, Ohnishi H, Itami J, Tada T, Saeki N (2005) Lack of benefit of spinal irradiation in the primary treatment of intracranial germinoma: a multiinstitutional, retrospective review of 180 patients. Cancer 104(1):126–134PubMedCrossRef

58.

Shim KW, Kim TG, Suh CO, Cho JH, Yoo CJ, Choi JU, Kim JH, Kim DS (2007) Treatment failure in intracranial primary germinomas. Childs Nerv Syst 23(10):1155–1161PubMedCrossRef

59.

Shirato H, Nishio M, Sawamura Y, Myohjin M, Kitahara T, Nishioka T, Mizutani Y, Abe H, Miyasaka K (1997) Analysis of long-term treatment of intracranial germinoma. Int J Radiat Oncol Biol Phys 37(3):511–515PubMedCrossRef

60.

Sugiyama K, Uozumi T, Goishi J, Sogabe T, Arita K, Maeda H, Ikawa F (1994) Germinoma of the medulla oblongata—case report. Neurol Med Chir (Tokyo) 34(5):291–294CrossRef

61.

Sung DI, Harisliadis L, Chang CH (1978) Midline pineal tumors and suprasellar germinomas: highly curable by irradiation. Radiology 128(3):745–751PubMed

62.

Ueki KTR (1980) Treatments and prognoses of pineal tumors—experience of 110 cases. Neurol Med Chir (Tokyo) 20:1–26CrossRef

63.

Wara WM, Fellows CF, Sheline GE, Wilson CB, Townsend JJ (1977) Radiation therapy for pineal tumors and suprasellar germinomas. Radiology 124(1):221–223PubMed

64.

Wara WM, Jenkin RD, Evans A, Ertel I, Hittle R, Ortega J, Wilson CB, Hammond D (1979) Tumors of the pineal and suprasellar region: Childrens Cancer Study Group treatment results 1960–1975: a report from Childrens Cancer Study Group. Cancer 43(2):698–701PubMedCrossRef

65.

Wolden SL, Wara WM, Larson DA, Prados MD, Edwards MS, Sneed PK (1995) Radiation therapy for primary intracranial germ-cell tumors. Int J Radiat Oncol Biol Phys 32(4):943–949PubMedCrossRef

66.

Yoo KH, Lee SH, Lee J, Sung KW, Jung HL, Koo HH, Lim do H, Kim JH, Shin HJ (2010) Improved outcome of central nervous system germ cell tumors: implications for the role of risk-adapted intensive chemotherapy. J Korean Med Sci 25(3):458–465PubMedCrossRef

Title: Treatment strategy for intracranial primary pure germinoma
Authors: Kyu-Won Shim
Eun Kyung Park
Yoon-Ho Lee
Chang-Ok Suh
Jaeho Cho
Joong-Uhn Choi
Dong-Seok Kim
Publication date: 01-02-2013
Publisher: Springer-Verlag
Published in: Child's Nervous System / Issue 2/2013
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-012-1902-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Treatment strategy for intracranial primary pure germinoma

Abstract

Object

Materials and methods

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Object

Materials and methods

Conclusion

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