A Multimodal Approach Including Craniospinal Irradiation Improves the Treatment Outcome of High-risk Intracranial Nongerminomatous Germ Cell Tumors

Journal Article · Thu Nov 01 04:00:00 EDT 2012 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2011.12.077· OSTI ID:22149560

Kim, Jun Won ^[1]; Kim, Woo Chul ^[2]; Cho, Jae Ho ^[1]; Kim, Dong-Seok; Shim, Kyu-Won ^[3]; Lyu, Chul Joo; Won, Sung Chul ^[4]; Suh, Chang-Ok ^[1]

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1. Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)
2. Department of Radiation Oncology, Inha University College of Medicine, Incheon (Korea, Republic of)
3. Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)
4. Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

Purpose: To evaluate whether a multimodal approach including craniospinal irradiation (CSI) improves treatment outcome in nongerminomatous germ cell tumor (NGGCT) patients. Methods and Materials: We reviewed the records of 32 patients with NGGCTs. Fourteen patients belonged to the intermediate prognosis group (immature teratoma, teratoma with malignant transformation, and mixed tumors mainly composed of germinoma or teratoma), and 18 patients belonged to the poor prognosis group (other highly malignant tumors). Patients with pure germinoma or mature teratoma were excluded from this study. Nineteen patients were treated with a combination of surgery, chemotherapy, and radiotherapy (RT); 9 patients received chemotherapy plus RT; 3 patients received surgery plus RT; and 1 patient received RT alone. Twenty-seven patients received CSI with a median of 36 Gy (range, 20-41 Gy) plus focal boost of 18-30.6 Gy, and 5 patients received whole-brain RT (WBRT) (20-36 Gy) or focal RT (50.4-54 Gy). The rate of total and subtotal resection was 71.9%. The median follow-up for surviving patients was 121 months. Results: Treatment failed in 7 patients. Three of the 5 patients who received focal RT or WBRT had local failure. Four cerebrospinal fluid (CSF) failures occurred after CSI. No failure occurred in the intermediate prognosis group. Ten-year recurrence-free survival (RFS) and overall survival (OS) for all patients were 77.6% and 74.6%, respectively. Ten-year RFS for the intermediate and poor prognosis groups were 100% and 61.1%, respectively (p = 0.012). OS for the two groups were 85.1% and 66.7%, respectively (p = 0.215). Tumor histology and CSI were significant prognostic factors for RFS, and CSI was significantly associated with OS. Conclusions: A multimodal approach was effective for treating NGGCTs. CSI should be considered for patients with poor prognostic histology.

• OSTI ID: 22149560
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 3 Vol. 84; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BRAIN
CEREBROSPINAL FLUID
CHEMOTHERAPY
FAILURES
GERM CELLS
GY RANGE 10-100
HEALTH HAZARDS
HISTOLOGY
IRRADIATION
NEOPLASMS
PATIENTS
RADIOTHERAPY
SURGERY