Intensive chemotherapy followed by reduced-dose radiotherapy for biopsy-proven CNS germinoma with elevated beta-human chorionic gonadotropin

Abstract

In this study, 10 patients with biopsy-proven germinoma with a beta-human chorionic gonadotropin (β-HCG) level >50 mIU/ml received intensive chemotherapy followed by reduced-dose radiotherapy (RT) to reduce late effects from RT. CSF β-HCG levels were >200 mIU/ml in five patients. After endoscopic or stereotactic biopsy, four cycles of induction chemotherapy were administered prior to RT. A CEB regimen (carboplatin + etoposide + bleomycin) and a CyEB regimen (cyclophosphamide + etoposide + bleomycin) were alternated. No residual tumor remained after induction chemotherapy in six patients, only cystic lesions were present at the primary tumor site in three, and a small solid residual tumor was observed in the remaining patient; however, all these patients had normal β-HCG levels. If complete response was achieved before initiation of RT, 19.5 Gy craniospinal RT (CSRT) + 10.8 Gy local RT was administered to the tumor bed. If residual lesion was suspected, the dose of RT was selected according to the presence/absence of tumor dissemination at diagnosis (19.5 Gy CSRT + 19.8 Gy local RT for localized tumors and 24.0 Gy CSRT + 16.2 Gy local RT for disseminated tumors). Eight patients, including four patients with a β-HCG level >200 mIU/ml, received 19.5 Gy CSRT. All patients remain disease free at a median follow-up of 58 (range 35-94) months from diagnosis. Our data suggest that pathologically pure germinoma with a significantly elevated β-HCG level might be cured with reduced-dose RT if intensive chemotherapy is provided.

Relapse pattern and quality of life in patients with localized basal ganglia germinoma receiving focal radiotherapy, whole-brain radiotherapy, or craniospinal irradiation

“…However, considering the similar incidence of relapse identified outside the CSF circulation route, incomplete CSF information could not fully explain the unique relapse pattern in patients with BG germinoma. Moreover, the sensitivity of CSF cytology varies significantly across institutes, with positivity rates as high as 52% in early reports and as low as 1.1% in studies with LGG [24] (n = 195) **p value Healthy population [24] (n = 205) **p value NHL/CLL [24] (n = 100) **p value GCTs [23] ( larger sample sizes [3,[30][31][32]. Based on our limited data, one of the seven patients with metastasis excluded from the current study tested positive by CSF cytology, while six were positive on MRI.…”

Tandem High-Dose Chemotherapy Increases the Risk of Secondary Malignant Neoplasm in Pediatric Solid Tumors

“…In the present study, RT > 2,340 cGy was a risk factor for SMN development, whereas no difference was observed in the development of SMN in patients who received RT ≤ 2,340 cGy compared to those who did not receive RT. Our center has adopted a strategy to reduce the RT dose to decrease late sequelae in pediatric cancer survivors, especially those with brain tumors, including intracranial germ cell tumors and medulloblastomas [ 7 , 28 , 29 ]. As RT is an important modality in the treatment of pediatric cancer, its use is inevitable; however, reducing the radiation dose whenever possible is crucial.…”

Treatment Outcome of a β-hCG Secreting Intracranial Germ Cell Tumor in an Adult Filipino using Definitive Chemotherapy followed by Radiotherapy: A Case Report

“…Chemotherapy with cyclophosphamide, ifosfamide, etoposide, cisplatin, and carboplatin were highly effective in CNS GCTs. 24 However, chemotherapy alone was proven to be inferior compared to radiotherapy-based treatment protocols. The Second International CNS Germ Cell Study Group showed that intensive chemotherapy was effective only in one-third of patients with 5-year event free survival and overall survival rates were 36% and 75%, respectively, and patients were salvaged through radiotherapy.…”