Prognosis of intracranial germ cell tumours: Effectiveness of chemotherapy with cisplatin and etoposide (CDDP and VP-16)

Abstract

A co-operative study for patients with intracranial germ cell tumours was performed to analyze their prognosis and the effectiveness of Cisplatin/Etoposide (CDDP/VP-16) chemotherapy. A total of 46 patients; 30 primary and 16 recurrent cases were registered from 15 participating neurosurgical institutions in Japan. Based on histological criteria and tumour markers, they were classified into three groups; germinoma, germinoma with syncytiotrophoblastic giant cell (STGC), and non-germinomatous malignant tumour. Sixteen patients were treated with CDDP/VP-16 chemotherapy alone and the other 30 patients were treated by a combination of surgery and/or radiation in addition to chemotherapy. Eleven out of 13 patients (85%) with germinoma showed a complete (n = 10) or partial (n = 1) response to CDDP/VP-16 chemotherapy even if their tumours were recurrent and there was evidence of CSF dissemination. For the germinoma with STGC and non-germinomatous malignant tumour, a high response rate; 100% for the former and 78% for the latter, could also be achieved in both the primary and the recurrent cases except in those cases of immature teratoma. Their survival times were still different between them. Two-year survival was 50% in germinoma with STGC and 48% in non-germinoma, while it was 88% in germinoma cases.

Lack of benefit of spinal irradiation in the primary treatment of intracranial germinoma

“…Uematsu and other investigators reported that intracranial germinoma with STGC showed a greater tendency to recur than pure germinoma. 42,45 However, Ogawa and other investigators reported that there was no significant difference between the survival of patients with and without STGC. 24,43 It will be important in future studies to evaluate whether these clinical parameters are truly associated with the treatment outcome.…”

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

“…Studies in new and relapsed patients found responses and/or improved survival after platinum-containing regimens [17][18][19][20][21][22][23][24][25], with one study suggesting synergy with etoposide [26]. Alkylating agents, such as cyclophosphamide (CPM) also were added with apparent efficacy in some trials [12,14,23].…”

Combined chemotherapy and radiation therapy for central nervous system germ cell tumors: preliminary results of a Phase II study of the Japanese Pediatric Brain Tumor Study Group

“…[10] Thereafter, a cisplatin-etoposide combination and carboplatin-etoposide combination were used in the phase II study by the Japanese Intracranial Germ Cell Tumor Study Group. [31] These trials obtained slightly better results in nongerminomatous tumors but failed to obtain any significant benefit.…”