Combined treatment with chemotherapy and radiation therapy for intracranial germ cell tumors

Abstract

We analyzed our treatment results in 153 patients with histologically verified intracranial germ cell tumors and proposed classifying them into three therapeutic groups with good prognosis, intermediate prognosis, and poor prognosis. In this work, we selected patients treated with chemotherapy (cisplatin or carboplatin combinations) in each subgroup, and we discuss the role of chemotherapy in their treatment. Our combination chemotherapy regimens are: cisplatin-vinblastine-bleomycin, cisplatin-etoposide, and carboplatin-etoposide. We delivered these chemotherapies to the last 33 patients and compared their treatment results with those obtained in the previous 31 patients, who were treated with conventional radiation therapy alone. A combination with chemotherapy and a reduced dose of irradiation with local field was given to 7 patients with germinoma to increase the cure rate and reduce radiation-induced side effects, including anterior pituitary dysfunction. We obtained an excellent initial response to chemotherapy. The chemotherapy we delivered had significantly better effects in the group with intermediate prognosis, but not in the group with poor prognosis. More aggressive chemotherapy and radiation therapy should be given as the initial treatment.

Pre‐radiation chemotherapy with response‐based radiation therapy in children with central nervous system germ cell tumors: A report from the Children's Oncology Group

“…If Patient 24 were to be excluded, the PFS for the high-risk group would be comparable at 76% (10 of 13 patients). Although for patients with nongerminomatous tumors very high tumor markers have been associated with a poor prognosis [38,39], elevated HCG in our nongerminomatous patients was not a prognostic factor with responses noted in three patients with blood and/or CSF HCG levels of 719-9,990 mIU/ml.…”

“…For nongerminomatous tumors and high-risk germinomas, our response rate (5 of 9) and PFS were comparable to recent reports: 21 of 26 [23], 12 of 18 [24], 21 of 27 [39], 16 of 17 [45]. However, these studies do not clarify whether increased intensification of chemotherapy, with concomitant increased toxicity, improves survival.…”

“…The largest recent French trial noted response to pre-radiation chemotherapy in all 38 evaluable patients with a 3-year EFS of 96.4% for 57 patients [33,36]. In the larger Japanese studies cited above, local radiation was reduced further to 24-30 Gy with EFS of 80-94% [15,39,43]. However, when RT is not given, most patients relapse despite excellent response rates to upfront chemotherapy [44].…”

Successful treatment of hemorrhagic congenital intracranial immature teratoma with neoadjuvant chemotherapy and surgery

“…20 It is recognized that, in older children, chemotherapy with platinum agents is effective for intracranial immature teratomas. 11,15,16 It is also known that neoadjuvant chemotherapy can induce differentiation of malignant germ cell tumors into mature teratomas. 8 The apparent tumor maturation presumably reflects the selective chemo-ablation of their actively proliferating components.…”

Diagnostic imaging of intracranial germ cell tumors. Review.

“…Germinomas respond well to chemoradiotherapy and their prognosis is relatively good. Mixed tumors composed of any type of teratoma and germinoma are also responsive to appropriate forms of combined therapy including surgery, radiation and/or chemotherapy, and thus their prognosis is better than that of other histological subtypes such as embryonal carcinoma, yolk sac tumor, choriocarcinoma or their mixtures (the so-called "poor prognosis" group), which require more intensive forms of chemo-radiotherapy [5,6]. For this reason, accurate differential diagnosis of these histological subtypes is very important in a clinical setting.…”