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Intracranial germinomas: a case for low dose radiation therapy alone

Abstract

Purpose: To determine the optimal dose and treatment outcome of patients treated with radiation for intracranial germinoma. Materials and Methods: Between 1975 and 1995, 39 patients with a diagnosis of intracranial germinoma were treated with radiation (RT) to the central nervous system. All but one pt received whole brain (WB) RT, (median dose: 3240 cGy range: 1500-4437 cGy) and a boost to the tumor volume (median total tumor volume dose: 5200 cGy, range: 3960-5950 cGy). Thirty-one pts received RT to the spine (median dose: 2500, range: 1875-3750). Eleven pts were treated with low dose RT and a tumor volume boost, (WB dose {<=} 2550 cGy, and spine dose {<=} 2160 cGy). Five pts were treated with cisplatin-based chemotherapy and low dose WB RT. Fifteen pts were biopsy-proven and 18 presented with multiple midline germinomas (MMG). Among all pts, 33% had serum or CSF positive for low levels of HCG and none of 19 (9 biopsy-proven) germinomas measured positive for AFP tumor marker. Six of 22 (27%) pts who had spine imaging or CSF cytology had evidence of tumor seeding. The male-to female-ratio was 1.4. Median age at diagnosis was 14 yrs for male pts and 9.5 yrs for females (p=.02,  More>>
Publication Date:
Jul 01, 1995
Product Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 32; Journal Issue: 971; Other Information: Copyright (c) 1995 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); PBD: 1995
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BRAIN; CHEMOTHERAPY; CYTOLOGY; HCG; LOW DOSE IRRADIATION; NEOPLASMS; OPTIMIZATION; RADIOTHERAPY; SURVIVAL CURVES; TOXICITY; VERTEBRAE
OSTI ID:
20420654
Country of Origin:
United States
Language:
English
Other Identifying Numbers:
Journal ID: ISSN 0360-3016; IOBPD3; TRN: US03R1890005059
Submitting Site:
INIS
Size:
page(s) 208
Announcement Date:

Citation Formats

Harrigan, Patricia M, Loeffler, Jay S, Shrieve, Dennis, and Tarbell, Nancy J. Intracranial germinomas: a case for low dose radiation therapy alone. United States: N. p., 1995. Web. doi:10.1016/0360-3016(95)97798-6.
Harrigan, Patricia M, Loeffler, Jay S, Shrieve, Dennis, & Tarbell, Nancy J. Intracranial germinomas: a case for low dose radiation therapy alone. United States. doi:10.1016/0360-3016(95)97798-6.
Harrigan, Patricia M, Loeffler, Jay S, Shrieve, Dennis, and Tarbell, Nancy J. 1995. "Intracranial germinomas: a case for low dose radiation therapy alone." United States. doi:10.1016/0360-3016(95)97798-6. https://www.osti.gov/servlets/purl/10.1016/0360-3016(95)97798-6.
@misc{etde_20420654,
title = {Intracranial germinomas: a case for low dose radiation therapy alone}
author = {Harrigan, Patricia M, Loeffler, Jay S, Shrieve, Dennis, and Tarbell, Nancy J}
abstractNote = {Purpose: To determine the optimal dose and treatment outcome of patients treated with radiation for intracranial germinoma. Materials and Methods: Between 1975 and 1995, 39 patients with a diagnosis of intracranial germinoma were treated with radiation (RT) to the central nervous system. All but one pt received whole brain (WB) RT, (median dose: 3240 cGy range: 1500-4437 cGy) and a boost to the tumor volume (median total tumor volume dose: 5200 cGy, range: 3960-5950 cGy). Thirty-one pts received RT to the spine (median dose: 2500, range: 1875-3750). Eleven pts were treated with low dose RT and a tumor volume boost, (WB dose {<=} 2550 cGy, and spine dose {<=} 2160 cGy). Five pts were treated with cisplatin-based chemotherapy and low dose WB RT. Fifteen pts were biopsy-proven and 18 presented with multiple midline germinomas (MMG). Among all pts, 33% had serum or CSF positive for low levels of HCG and none of 19 (9 biopsy-proven) germinomas measured positive for AFP tumor marker. Six of 22 (27%) pts who had spine imaging or CSF cytology had evidence of tumor seeding. The male-to female-ratio was 1.4. Median age at diagnosis was 14 yrs for male pts and 9.5 yrs for females (p=.02, overall age range: 1-31 yrs). Median follow-up for survivors is 64 months (range: 1-226 months). Toxicity of treatment relative to dose was assessed. Results: The 5-yr. actuarial rate of disease-free survival (DFS) and overall survival for presumed germinomas was 97%. No pts died of germinoma. One pt died of a shunt infection who had received concurrent chemotherapy and low dose whole brain RT. Among the low dose RT alone group 6 pts received whole brain RT of {<=} 2550 cGy and 9 pts were treated with spinal RT of {<=} 2160 cGy without chemotherapy. Two of these pts had CSF cytology positive for tumor seeding. Additionally, 8 pts received a total dose to the tumor volume of {<=} 4800 cGy without chemotherapy. The 5-yr DFS was 100%. Five pts were treated with cisplatin-based chemotherapy followed by low dose RT. There were 2 CRs and 1 PR after 3 cycles, and 2 PRs after 1 cycle (chemotherapy was discontinued after 1 cycle due to ototoxicity). Among 18 pts treated with {<=} 3060 cGy WB RT (median follow-up: 35 mos), the most striking toxicity was in (4(5)) pts treated with chemotherapy who developed ototoxicity prior to RT. One pt had worsening of neuropsychological function which was present at diagnosis and 5 pts developed endocrinopathies. Among 20 pts treated with > 3060 cGy WB RT (median follow-up: 72 mos) there were 7 new or worsened neuropsychological outcomes. There were 10 pts who developed endocrinopathies. One female pt who received high dose WB RT was diagnosed with a glioblastoma multiforme within the treatment field 6 yrs after CSI. Conclusions: 1) Germinomas are highly curable with RT alone. 2.) These results suggest that low dose RT alone to the craniospinal axis (2000 cGy) and a boost to the tumor volume (4500 cGy) is effective and associated with few treatment complications. This may be more clearly indicated for pts with MMG or evidence of spinal seeding. Further experience is necessary to confirm this. 3.) The toxicity associated with high dose RT or chemotherapy and low dose RT argues against its use in germinomas.}
doi = {10.1016/0360-3016(95)97798-6}
journal = {International Journal of Radiation Oncology, Biology and Physics}
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}