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Title: Upfront Chemotherapy and Involved-Field Radiotherapy Results in More Relapses Than Extended Radiotherapy for Intracranial Germinomas: Modification in Radiotherapy Volume Might Be Needed

Abstract

Purpose: To retrospectively compare the outcome of upfront chemotherapy plus radiotherapy (CRT) and the outcome of the use of extended radiotherapy (RT) only for intracranial germinoma. Methods and Materials: Of 81 patients with tissue-confirmed intracranial germinoma, 42 underwent CRT and 39 underwent RT only. For CRT, one to five cycles of upfront chemotherapy was followed by involved-field or extended-field RT, for which the dose was dependent on the M stage. For RT only, all 39 patients underwent craniospinal RT alone. The median follow-up was 68 months. Results: The 5- and 10-year overall survival rate was 100% and 92.5% for RT alone and 92.9% and 92.9% for CRT, respectively. The 5-year recurrence-free survival rate was 100.0% for RT and 88.1% for CRT (p = 0.0279). No recurrences developed in patients given RT, but four relapses developed in patients who had received CRT-three in the brain and one in the spine. Only one patient achieved complete remission from salvage treatment. The proportion of patients requiring hormonal replacement was greater for patients who received RT than for those who had received CRT (p = 0.0106). Conclusions: The results of our study have shown that the better quality of life provided by CRT wasmore » compensated for by the greater rate of relapse. The possible benefit of including the ventricles in involved-field RT after upfront chemotherapy, specifically for patients with initial negative seeding, should be addressed in a prospective study.« less

Authors:
 [1];  [1];  [2];  [3]; ; ; ;  [1]; ; ; ;  [4];  [5]; ; ;  [6]
  1. Department of Radiation Oncology, Seoul National University College of Medicine, Seoul (Korea, Republic of)
  2. (Korea, Republic of)
  3. (Korea, Republic of), E-mail: ihkim@snu.ac.kr
  4. Department of Neurosurgery, Seoul National University College of Medicine, Seoul (Korea, Republic of)
  5. Department of Internal Medicine, Seoul National University College of Medicine, Seoul (Korea, Republic of)
  6. Department of Pediatrics, Seoul National University College of Medicine, Seoul (Korea, Republic of)
Publication Date:
OSTI Identifier:
21124301
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 71; Journal Issue: 3; Other Information: DOI: 10.1016/j.ijrobp.2008.01.061; PII: S0360-3016(08)00355-6; Copyright (c) 2008 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BRAIN; CHEMOTHERAPY; COMBINED THERAPY; HORMONES; PATIENTS; RADIATION DOSES; RADIOTHERAPY; VERTEBRAE

Citation Formats

Eom, Keun-Yong, Kim, Il Han, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Park, Charn Il, Kim, Hak Jae, Kim, Jin Ho., Kim, Kyubo, Kim, Seung Ki, Wang, Kyu-Chang, Cho, Byung-Gyu, Jung, Hee-Won, Heo, Dae Seog, Kang, Hyoung Jin, Shin, Hee Young, and Ahn, Hyo Seop. Upfront Chemotherapy and Involved-Field Radiotherapy Results in More Relapses Than Extended Radiotherapy for Intracranial Germinomas: Modification in Radiotherapy Volume Might Be Needed. United States: N. p., 2008. Web. doi:10.1016/j.ijrobp.2008.01.061.
Eom, Keun-Yong, Kim, Il Han, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Park, Charn Il, Kim, Hak Jae, Kim, Jin Ho., Kim, Kyubo, Kim, Seung Ki, Wang, Kyu-Chang, Cho, Byung-Gyu, Jung, Hee-Won, Heo, Dae Seog, Kang, Hyoung Jin, Shin, Hee Young, & Ahn, Hyo Seop. Upfront Chemotherapy and Involved-Field Radiotherapy Results in More Relapses Than Extended Radiotherapy for Intracranial Germinomas: Modification in Radiotherapy Volume Might Be Needed. United States. doi:10.1016/j.ijrobp.2008.01.061.
Eom, Keun-Yong, Kim, Il Han, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Park, Charn Il, Kim, Hak Jae, Kim, Jin Ho., Kim, Kyubo, Kim, Seung Ki, Wang, Kyu-Chang, Cho, Byung-Gyu, Jung, Hee-Won, Heo, Dae Seog, Kang, Hyoung Jin, Shin, Hee Young, and Ahn, Hyo Seop. 2008. "Upfront Chemotherapy and Involved-Field Radiotherapy Results in More Relapses Than Extended Radiotherapy for Intracranial Germinomas: Modification in Radiotherapy Volume Might Be Needed". United States. doi:10.1016/j.ijrobp.2008.01.061.
@article{osti_21124301,
title = {Upfront Chemotherapy and Involved-Field Radiotherapy Results in More Relapses Than Extended Radiotherapy for Intracranial Germinomas: Modification in Radiotherapy Volume Might Be Needed},
author = {Eom, Keun-Yong and Kim, Il Han and Cancer Research Institute, Seoul National University College of Medicine, Seoul and Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul and Park, Charn Il and Kim, Hak Jae and Kim, Jin Ho. and Kim, Kyubo and Kim, Seung Ki and Wang, Kyu-Chang and Cho, Byung-Gyu and Jung, Hee-Won and Heo, Dae Seog and Kang, Hyoung Jin and Shin, Hee Young and Ahn, Hyo Seop},
abstractNote = {Purpose: To retrospectively compare the outcome of upfront chemotherapy plus radiotherapy (CRT) and the outcome of the use of extended radiotherapy (RT) only for intracranial germinoma. Methods and Materials: Of 81 patients with tissue-confirmed intracranial germinoma, 42 underwent CRT and 39 underwent RT only. For CRT, one to five cycles of upfront chemotherapy was followed by involved-field or extended-field RT, for which the dose was dependent on the M stage. For RT only, all 39 patients underwent craniospinal RT alone. The median follow-up was 68 months. Results: The 5- and 10-year overall survival rate was 100% and 92.5% for RT alone and 92.9% and 92.9% for CRT, respectively. The 5-year recurrence-free survival rate was 100.0% for RT and 88.1% for CRT (p = 0.0279). No recurrences developed in patients given RT, but four relapses developed in patients who had received CRT-three in the brain and one in the spine. Only one patient achieved complete remission from salvage treatment. The proportion of patients requiring hormonal replacement was greater for patients who received RT than for those who had received CRT (p = 0.0106). Conclusions: The results of our study have shown that the better quality of life provided by CRT was compensated for by the greater rate of relapse. The possible benefit of including the ventricles in involved-field RT after upfront chemotherapy, specifically for patients with initial negative seeding, should be addressed in a prospective study.},
doi = {10.1016/j.ijrobp.2008.01.061},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 3,
volume = 71,
place = {United States},
year = 2008,
month = 7
}
  • Purpose: The optimal therapy for primary mediastinal large B-cell lymphoma (PMLBCL) remains undefined. The superiority of intensive chemotherapy regimens (Methotrexate, Doxorubicin, Cyclophosphamide, Vincristine, Prednisone, Bleomycin [MACOP-B]/Etoposide, Doxorubicin, Cyclophosphamide, Vincristine, Prednisone, Bleomycin [VACOP-B]) over Cyclophosphamide, Doxorubicin, Vincristine, Prednisone (CHOP)-like chemotherapy is upheld by some authors. The role of radiotherapy is still debated. In the absence of randomized trials, we report clinical findings and treatment response in 53 consecutive patients treated with intensive chemotherapy and mediastinal involved-field radiation therapy (IFRT). Methods and Material: Fifty-three consecutive patients with PMLBCL were retrospectively analyzed. Planned treatment consisted of induction chemotherapy (I-CT; Prednisone, Methotrexate, Doxorubicin, Cyclophosphamide,more » Etoposide-Mechloroethamine, Vincristine, Procarbazine, Prednisone [ProMACE-MOPP] in the first 2 patients, MACOP-B in the next 11, and VACOP-B in the last 40) followed by IFRT. Planned treatment was concluded in 43 of 53 patients; in 10 patients, I-CT was not immediately followed by IFRT. Among these 10 patients, 6 received high-dose chemotherapy (HD-CT) followed by IFRT, 2 received HD-CT, and 2 received no further treatment. Results: After a median follow-up of 93.9 months (range, 6-195 months), 45 of 53 patients (84.9%) were alive without disease. Eight patients died: 7 of PMLBCL and 1 of toxicity during HD-CT. The 5-year disease-free survival (DFS) and overall survival rates were 93.42% and 86.6%, respectively. The response rates after I-CT were complete response (CR) in 20 (37.73%) and partial response (PR) in 30 (56.60%); 3 patients (5.66%) were considered nonresponders. Among patients in PR after chemotherapy, 92% obtained a CR after IFRT. Conclusions: Our report confirms the efficacy of intensive chemotherapy plus mediastinal IFRT. IFRT plays a pivotal role in inducing CR in patients in PR after chemotherapy.« less
  • A series of 44 previously untreated patients was found to have stage I or II Hodgkin's disease on the basis of a diagnostic workup which included laparotomy and splenectomy in 39 cases. The patients were randomized to either involved field or extended field radiotherapy. No difference was found in overall survival rates between the two groups. Regional recurrences were seen in four patients in the involved field group and in none of the extended field group. Radiotherapy to the extended field treatment port (generally an extended mantle) can be given with acceptable side effects. Staging laparotomy was of definite value,more » changing the classification and resulting therapy of two groups: patients with clinical stage (CS) I or II, pathologic stage (PS) III involvement, who were treated with appropriately larger radiotherapy fields; and patients with CS III, PS I or II, who were spared unnecessarily extensive radiotherapy.« less
  • With the advent of adjuvant chemotherapy in 1974 for early operable breast cancer at Massachusetts General Hospital, 41 patients with GAMMAreater than or equal to 4 lymph nodes positive in their axillary dissection received a two-year course of the modified Cooper regimen (S + CH) between March 1974 and June 1976. The actuarial disease-free survival was found to be comparable to CMF as reported by Bonnadonna. No consistent randomization with a control group was possible. Since postoperative radiotherapy has been proven to decrease the incidence of local recurrence but does not affect survival, it was believed that this group shouldmore » serve as an adequate control. Sixty patients with GAMMAreater than or equal to 4 positive axillary lymph nodes in their axillary dissection who were given postoperative radiotherapy to the chest wall and draining lymphatics (S + RT) in 1973 and 1974 at the same institution were retrospectively analyzed and compared to the above group. Relatively little significant difference in survival and disease-free survival curves was found. At 48 months, there was 72% and 58% survival for the S + RT and S + CH groups, respectively. When subgrouped according to age, those patients <49-years-old had a 48-month disease-free survival of 65% and 49% for S + RT and S + CH groups, respectively (P=0.25). No significant difference was noted in the post menopausal group. In both groups, patients with >50% positive axillary lymph nodes exhibited a poor prognosis.« less
  • Purpose: Avoidance radiotherapy or reduction of irradiation doses in patients with primary central nervous system lymphoma (PCNSL) in complete remission (CR) after high-dose methotrexate (HD-MTX)-based chemotherapy has been proposed to minimize the neurotoxicity risk. Nevertheless, no study has focused on the survival impact of radiation parameters, as far as we know, and the optimal radiation schedule remains to be defined. Methods and Materials: The impact on outcome and neurologic performance of different radiation fields and doses was assessed in 33 patients with PCNSL who achieved CR after MTX-containing chemotherapy and were referred to consolidation whole-brain irradiation (WBRT). Patterns of relapsemore » were analyzed on computed tomography-guided treatment planning, and neurologic impairment was assessed by the Mini Mental Status Examination. Results: At a median follow-up of 50 months, 21 patients are relapse-free (5-year failure-free survival [FFS], 51%). WBRT doses {>=}40 Gy were not associated with improved disease control in comparison with a WBRT dose of 30 to 36 Gy (relapse rate, 46% vs. 30%; 5-year FFS, 51% vs. 50%; p = 0.26). Disease control was not significantly different between patients irradiated to the tumor bed with 45 to 54 Gy or with 36 to 44 Gy, with a 5-year FFS of 35% and 44% (p = 0.43), respectively. Twenty patients are alive (5-year overall survival, 54%); WB and tumor bed doses did not have an impact on survival. Impairment as assessed by the Mini Mental Status Examination was significantly more common in patients treated with a WBRT dose {>=}40 Gy. Conclusion: Consolidation with WBRT 36 Gy is advisable in patients with PCNSL in CR after HD-MTX-based chemotherapy. Higher doses do not change the outcome and could increase the risk of neurotoxicity.« less
  • Purpose: To establish benchmark outcomes for combined modality treatment to be used in future prospective studies of osteolymphoma (primary bone lymphoma). Methods and Materials: In 1999, the Trans-Tasman Radiation Oncology Group (TROG) invited the Australasian Leukemia and Lymphoma Group (ALLG) to collaborate on a prospective study of limited chemotherapy and radiotherapy for osteolymphoma. The treatment was designed to maintain efficacy but limit the risk of subsequent pathological fractures. Patient assessment included both functional imaging and isotope bone scanning. Treatment included three cycles of CHOP chemotherapy and radiation to a dose of 45 Gy in 25 fractions using a shrinking fieldmore » technique. Results: The trial closed because of slow accrual after 33 patients had been entered. Accrual was noted to slow down after Rituximab became readily available in Australia. After a median follow-up of 4.3 years, the five-year overall survival and local control rates are estimated at 90% and 72% respectively. Three patients had fractures at presentation that persisted after treatment, one with recurrent lymphoma. Conclusions: Relatively high rates of survival were achieved but the number of local failures suggests that the dose of radiotherapy should remain higher than it is for other types of lymphoma. Disability after treatment due to pathological fracture was not seen.« less