Change in treatment strategy for intracranial germinoma: Long-term follow-up experience at a single institute

Authors

  • Yi-Wei Chen MD,

    1. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
    2. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
    3. Division of Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Pin-I Huang MD,

    1. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
    2. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
    3. Division of Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Donald Ming-Tak Ho MD,

    1. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
    2. Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Yu-Wen Hu MD,

    1. Division of Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Kai-Ping Chang MD,

    1. Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Shih-Hwa Chiou MD, PhD,

    1. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
    2. Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Wan-Yuo Guo MD, PhD,

    1. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
    2. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Feng-Chi Chang MD,

    1. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
    2. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Muh-Lii Liang MD,

    1. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
    2. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
    3. Division of Pediatric Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan; Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Yi-Yen Lee MD,

    1. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
    2. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
    3. Division of Pediatric Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan; Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Hsin-Hung Chen MD,

    1. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
    2. Division of Pediatric Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan; Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Ting-Rong Hsu MD,

    1. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
    2. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
    3. Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Shih-Chieh Lin MD,

    1. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
    2. Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Tai-Tong Wong MD,

    1. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
    2. Division of Pediatric Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan; Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Sang-Hue Yen MD

    Corresponding author
    1. Division of Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
    2. Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
    • Cancer Center, Taipei Veterans General Hospital, 201, Sec.2, Shih-Pai Road, Taipei 112, Taiwan; Fax (886) 2-28749425; shyen@vghtpe.gov.tw; OR Tai-Tong Wong, MD, Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, 201, Sec.2, Shih-Pai Road, Taipei 112, Taiwan

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Abstract

BACKGROUND:

Previous intracranial germinoma (IG) studies have investigated the effect of different radiotherapy (RT) volumes and the necessity for adjunctive chemotherapy, but there is currently no consensus on the best treatment for this tumor.

METHODS:

From January 1989 to December 2009, 80 IG patients (≤20 years old) were treated with various RT regimens. Of them, 14 patients had craniospinal irradiation (CSI) + primary boost (PB); 8 patients had whole-brain irradiation (WBI) + PB; 31 patients had whole ventricular irradiation (WVI) + PB; and 27 patients had focal RT only. Twenty-nine patients (36.2%) also received systemic chemotherapy (CHT). Survival was estimated by the Kaplan-Meier method and variables affecting survival were analyzed by the Cox proportional hazard model.

RESULTS:

Eleven patients (13.8%) developed local recurrence or dissemination after treatment, and 10 of these patients were in the focal RT group. The 5-year relapse-free survival (RFS) for the CSI, WBI, WVI, and focal RT patients were 100%, 85.7%, 100%, and 84.6%, respectively (P = .001). The 5-year overall survival (OS) for CSI, WBI, WVI, and focal RT patients was 100%, 83.3%, 100%, and 87.9%, respectively (P = .125). Focal irradiation (P = .02) and initial use of CHT (P = .021) were negatively associated with RFS.

CONCLUSIONS:

Focal RT plus CHT were associated with inferior control of IG and a higher incidence of CHT-related toxicities. Adjustment of the radiation volume to the whole ventricular system without CHT is sufficient for treatment of nondisseminated IGs, even with lower primary RT doses (<36 Gy). Cancer 2011. © 2011 American Cancer Society.

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