Carboplatin-based regimen in pediatric intracranial germ-cell tumors (IC-GCTs): effectiveness and ototoxicity

Abstract

Background Induction chemotherapy with carboplatin followed by radiotherapy has been used for many years for treating intracranial germ-cell tumors (IC-GCTs) in Thailand. The objective of this study was to assess treatment outcomes, focusing on survival and ototoxicity. Methods The outcomes of all patients with IC-GCT treated at Ramathibodi Hospital and the Prasat Neurological Institute between 2000 and 2017 were reviewed and analyzed, including all patient characteristics and treatment modalities. Five-year overall survival (OS) and event-free survival (EFS) were analyzed using the Kaplan-Meier method, and factors affecting survival were compared using the log-rank test. Results Fifty-three patients age 1-14 years (median, 11 years) were included in this study. The median follow-up time was 63 months. The 5-year EFS and OS rates were 94.3% and 96.2% for all patients, respectively. No statistical difference in OS or EFS was observed between the data of recipients in the carboplatin-based and historical cisplatin-based therapies in our institutes. Concerning radiotherapy, omission of radiotherapy or focal irradiation results in worse long-term survival outcomes, but reduction in dose of radiotherapy to less than 40 Gy did not cause any negative impact on survival rates. Furthermore, carboplatin was associated with lower rates of hearing loss than cisplatin (5.7% vs 87.5%). Conclusions Induction chemotherapy with carboplatin-based regimens was associated with excellent survival rates and low ototoxicity in patients with IC-GCT. Radiotherapy should be given to all patients with a minimal volume equivalent to whole-ventricular radiotherapy, during which doses of lower than 40 Gy can be effectively used.

Clinical Outcomes and Diagnostic Consistency of Serum and CSF Tumor Markers in Pediatric Intracranial Germ Cell Tumors in Thailand: A Multicenter Study

“…Our study confirmed that irradiation combined with chemotherapy was a fundamental treatment to achieve outcomes, 6 , 29 , 30 and an independent risk factor for survival outcomes in pediatric ICGCTs. Worawongsakul 10 and Villano et al 20 reported significantly inferior outcomes among patients with ICGCTs treated without irradiation compared with those who undergoing irradiation. In the Western population, the 3-year PFS and OS of NGGCTs were 88% and 93%, respectively.…”

“…Carboplatin-based regimen instead of cisplatin followed by irradiation has been employed as a standard regimen for childhood ICGCTs in Thailand since 2013. Worawongsakul et al 10 reported an excellent OS of 96% and EFS of 94% for patients with ICGCTs treated with a carboplatin-based regimen with lower ototoxicity effects. They found that germinomas had higher OS and EFS but without statistical significance, similar to our report.…”

“… 9 These protocols were primarily used to treat pediatric patients with ICGCTs in Thailand since 2000 with effectiveness and lower ototoxicity over cisplatin-based regimens. 10 …”

Intracranial germ cells tumour: a single institution experience in Argentina

“…Due to the limitation of health care resources, protocols in LMIC should not only consider survival, but also feasibility. The treatment of malignant childhood brain tumours remains a challenge in LMIC as it requires a multidisciplinary team that may not available worldwide, such as access to chemotherapy, surgical expertise, supportive care and radiation facilities.Although the SIOP-CNS-GCT-96 strategy is followed by many countries across the world, the viability and survival outcome in theLMICsetting is not well described.Despite small series [20][21][22], there is a paucity of data to understand if this combined regimen would be considered a possible and practicable strategy outside the developed world. Here, we evaluate the outcome of a cohort of iGCT treated using the SIOP-CNS-GCT-96 approach prior to 2009 followed by the adoption of the North American approach of whole ventricular radiotherapy after 2009 at Hospital JP Garrahan in Buenos Aires.…”

Intracranial Germ Cells Tumour: a single institution experience in Argentina

“…Due to the limitation of health care resources, protocols in LMIC should not only consider survival, but also feasibility. The treatment of malignant childhood brain tumours remains a challenge in LMIC as it requires a multidisciplinary team that may not available worldwide, such as access to chemotherapy, surgical expertise, supportive care and radiation facilities.Although the SIOP-CNS-GCT-96 strategy is followed by many countries across the world, the viability and survival outcome in theLMICsetting is not well described.Despite small series [20][21][22], there is a paucity of data to understand if this combined regimen would be considered a possible and practicable strategy outside the developed world. Here, we evaluate the outcome of a cohort of iGCT treated using the SIOP-CNS-GCT-96 approach prior to 2009 followed by the adoption of the North American approach of whole ventricular radiotherapy after 2009 at Hospital JP Garrahan in Buenos Aires.…”