Chemotherapy without irradiation--a novel approach for newly diagnosed CNS germ cell tumors: results of an international cooperative trial. The First International Central Nervous System Germ Cell Tumor Study.

Abstract

Forty-one percent of surviving patients and 50% of all patients were treated successfully with chemotherapy only without irradiation. Chemotherapy-only regimens for CNS GCT, although encouraging, should continue to be used only in the setting of formal clinical trials.

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

“…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.…”

“…CCDP, etoposide, and a VCR were used in this study based on reported response rates for germ cell tumors of the testes [27,28], and of the CNS [21,23,29]. CMP was added due to high response rates reported for single agent CNS treatment [30,31].…”

“…For nongerminomatous patients, the platinum dose was doubled based on data for systemic germ cell tumors, and for CNS nongerminomatous patients (86% survival after 400 mg/m 2 vs. 56% following 200 mg/m 2 ) [14,32]. The CMP dose was increased because of responses noted after single agent treatment in newly diagnosed and refractory disease [23].…”

“…While 5% of germinomas may contain syncytiotrophoblastic giant cells that secrete HCG [34], controversy exists regarding the prognostic significance of modest elevations of HCG [35]. Buckner et al noted excellent response and survival in three patients with CSF HCG 79.6-147 mIU/ml [16], whereas Balmaceda et al noted a trend toward increased PD (P 0.06) in 29 patients [23]. It remains unclear whether patients¼with pure germinoma and HCG 50-2,000 mIU/ml (e.g., Patient 24) should be classified as high-risk patients, but our intent was to follow the guidelines of previous European series [5,14,25,33,[35][36][37].…”

“…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].…”