High‐dose chemotherapy with autologous stem cell transplantation spares re‐irradiation for recurrent intracranial germinoma

Kubota, Hirohito; Umeda, Katsutsugu; Kouzuki, Kagehiro; Tanaka, Kuniaki; Daifu, Tomoo; Hamabata, Takayuki; Nodomi, Seishiro; Kato, Ikunoshin; Hiramatsu, Hidefumi; Arakawa, Yoshiki; Mizowaki, Takashi; Adachi, Souichi

doi:10.1002/pbc.27104

Cited by 9 publications

(3 citation statements)

References 19 publications

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“…However, another study found high-dose chemotherapy effective against recurrent germinoma without radiation therapy, with four of six patients surviving without recurrence after high-dose chemotherapy without salvage irradiation for 12, 96, 112 and 114 months [ 27 ]. The authors speculated that intensive chemotherapy prior to high-dose chemotherapy may result in a more profound complete response of recurrent disease [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Salvage craniospinal irradiation for recurrent intracranial germinoma: a single institution analysis

Kanamori

Shimoda

Umezawa

et al. 2023

Journal of Radiation Research

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This study investigated the effectiveness and safety of low-dose salvage craniospinal irradiation (CSI) for recurrent germinoma. We retrospectively reviewed long-term tumor control and late adverse effects in 15 recurrent germinoma patients treated at our hospital between 1983 and 2019. Following the first recurrence of germinoma, seven were treated with 24–30 Gy of salvage CSI, three underwent non-CSI, and five were treated with only chemotherapy. CSI achieved a significantly better recurrence-free survival rate after the first recurrence compared to other strategies (100% vs 33%, p < 0.001: log-rank test). To evaluate the safety of salvage CSI, we assessed the outcomes at the final follow-up of seven patients who received salvage CSI at first recurrence and three patients who received salvage CSI at second recurrence. The median follow-up period was 220 months after initial treatment. Five patients who received 40–50 Gy of radiation therapy or underwent multiple radiation therapy before salvage CSI were classified into Group A, whereas five patients treated with platinum-based chemotherapy and 24–32 Gy of radiation therapy to the primary site, whole ventricle, or whole brain were classified into Group B. In Group A, one had endocrine dysfunction and the other had visual dysfunction. None were socially independent. Meanwhile, in Group B, no endocrine or visual dysfunction was found, and three patients were socially independent. Salvage CSI achieved excellent tumor control in recurrent germinoma and was safe in patients initially treated with low-dose radiation therapy and chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Salvage craniospinal irradiation for recurrent intracranial germinoma: a single institution analysis

Kanamori

Shimoda

Umezawa

et al. 2023

Journal of Radiation Research

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“…At relapse, GCT remains chemosensitive [ 85 ]. Thiotepa-based or melphalan-based HDC regimens followed by ASCR could be proposed [ 96 , 97 , 98 , 99 ]. For nongerminomatous GCT, the GEMPOX protocol, composed of gemcitabine, paclitaxel, and oxaliplatin, was associated with interesting responses in three patients [ 100 ].…”

Section: The Role Of Sytemic Treatmentmentioning

confidence: 99%

Diagnosis and Treatment of Pineal Region Tumors in Adults: A EURACAN Overview

Lombardi

Poliani

Manara

et al. 2022

Cancers

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Pineal region tumors are rare intracranial tumors, accounting for less than 1% of all adult intracranial tumor lesions. These lesions represent a histologically heterogeneous group of tumors. Among these tumors, pineal parenchymal tumors and germ cell tumors (GCT) represent the most frequent types of lesions. According to the new WHO 2021 classification, pineal parenchymal tumors include five distinct histotypes: pineocytoma (PC), pineal parenchymal tumors of intermediate differentiation (PPTID), papillary tumor of the pineal region (PTPR), pinealoblastoma (PB), and desmoplastic myxoid tumor of the pineal region, SMARCB1-mutant; GCTs include germinoma, embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma, mixed GCTs. Neuroradiological assessment has a pivotal role in the diagnostic work-up, surgical planning, and follow-up of patients with pineal masses. Surgery can represent the mainstay of treatment, ranging from biopsy to gross total resection, yet pineal region tumors associated with obstructive hydrocephalus may be surgically managed via ventricular internal shunt or endoscopic third ventriculostomy. Radiotherapy remains an essential component of the multidisciplinary treatment approach for most pineal region tumors; however, treatment volumes depend on the histological subtypes, grading, extent of disease, and the combination with chemotherapy. For localized germinoma, the current standard of care is chemotherapy followed by reduced-dose whole ventricular irradiation plus a boost to the primary tumor. For pinealoblastoma patients, postoperative radiation has been associated with higher overall survival. For the other pineal tumors, the role of radiotherapy remains poorly studied and it is usually reserved for aggressive (grade 3) or recurrent tumors. The use of systemic treatments mainly depends on histology and prognostic factors such as residual disease and metastases. For pinealoblastoma patients, chemotherapy protocols are based on various alkylating or platinum-based agents, vincristine, etoposide, cyclophosphamide and are used in association with radiotherapy. About GCTs, their chemosensitivity is well known and is based on cisplatin or carboplatin and may include etoposide, cyclophosphamide, or ifosfamide prior to irradiation. Similar regimens containing platinum derivatives are also used for non-germinomatous GCTs with very encouraging results. However, due to a greater understanding of the biology of the disease’s various molecular subtypes, new agents based on targeted therapy are expected in the future. On behalf of the EURACAN domain 10 group, we reviewed the most important and recent developments in histopathological characteristics, neuro-radiological assessments, and treatments for pineal region tumors.

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“…The treatment includes chemotherapy (carboplatin, etoposide) and radiation therapy (18 Gy WV with a 12 Gy boost to the primary site). High-dose chemotherapy followed by autologous stem cell transplantation may be effective in patients with relapsed or progressive disease [ 37 ]. Because a number of patients are resistant or relapse after curative treatment, there is a pressing need for new therapeutic options.…”

Section: Intracranial Germinomamentioning

confidence: 99%

Pituitary stalk thickening in patients under 18 years of age – the most common causes and diagnostic procedures

Moszczyńska¹,

Baszyńska-Wilk²,

Zasada³

et al. 2022

pedm

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Introduction Pituitary stalk thickening (PST) is a rare abnormality in children, and it may be challenging due to its diverse clinical picture. The aim of the study is to summarize the data on the causes and diagnostic procedures of PST. Material and methods Papers were searched in the PubMed database identifying published randomized clinical trials, reviews, systematic reviews, meta-analyses, and case reports. Results The most common causes of a thickened pituitary stalk in children are germ cell tumours (GCTs), Langerhans cell histiocytosis (LCH), and lymphocytic infundibulo-neurohypophysitis (LINH). Neurosarcoidosis, pituitary tuberculosis, granulomatosis, or specific inflammations were only reported in the paediatric population as case studies. PST mainly affects teenagers and is often detected with brain magnetic resonance imaging (MRI) in patients with central diabetes insipidus (CDI). It is not possible to differentiate the causes of PST with the use of the MRI image alone. Although various biochemical and oncological markers and other imaging tests are used, the diagnosis of PST remains a significant diagnostic challenge for clinicians. The final diagnosis is made based on histopathological examination. The indications for a biopsy are not uniform. Most experts, including the authors of the 2021 British consensus, recommend biopsy in the case of PST with a stalk lesion diameter ≥ 6.5–7 mm. Conclusions The differential diagnosis of PST is a challenge. The diagnostic and treatment strategy should be individually adapted. Patients should be diagnosed in large clinical centres with experience in this field.

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High‐dose chemotherapy with autologous stem cell transplantation spares re‐irradiation for recurrent intracranial germinoma

Cited by 9 publications

References 19 publications

Salvage craniospinal irradiation for recurrent intracranial germinoma: a single institution analysis

Salvage craniospinal irradiation for recurrent intracranial germinoma: a single institution analysis

Diagnosis and Treatment of Pineal Region Tumors in Adults: A EURACAN Overview

Pituitary stalk thickening in patients under 18 years of age – the most common causes and diagnostic procedures

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