Late recurrence and salvage therapy of CNS germinomas

Kamoshima, Yuuta; Sawamura, Yutaka; Ikeda, Jun; Shirato, Hiroki; Aoyama, Hidefumi

doi:10.1007/s11060-008-9649-7

Cited by 44 publications

(27 citation statements)

References 30 publications

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“…10 Therefore, the latency of recurrence in germinoma could be longer than that in the intermediate prognosis NGGCT group, and result in poorer PFS time in the long-term follow-up period.…”

Section: Treatment and Outcomes In The Germinoma Groupmentioning

confidence: 99%

Optimal treatment strategy for intracranial germ cell tumors: a single institution analysis

Kanamori¹,

Kumabe²,

Saito³

et al. 2009

PED

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Object This study retrospectively analyzed the long-term outcomes of 108 consecutive patients to establish the classification and optimal treatment strategy for each subgroup of newly diagnosed germ cell tumors (GCTs). Methods A retrospective review of medical records from the authors' department between April 1989 and March 2007 identified 108 patients with newly diagnosed intracranial GCT. The diagnoses were germinoma in 83 patients, and nongerminomatous GCT (NGGCT) in 25 patients. Results In patients with germinoma, the 10-year overall and progression-free survival (PFS) rates at a median follow-up period of 99 months were 86 and 74%, respectively. Recurrences developed during a range of 6 to 153 months (median 26 months) after starting the initial therapy. Patients treated only with chemotherapy demonstrated a shorter PFS rate, and patients treated with chemotherapy followed by reduced-dose radiation therapy to the whole ventricle, whole brain, or craniospinal axis showed significantly better PFS than patients treated with only radiation or reduced-dose radiation therapy to the focal field. Nongerminomatous GCTs were divided into good, intermediate, and poor prognosis groups as proposed by the Japanese Pediatric Brain Tumor Study Group. In the good and intermediate prognosis groups, the 10-year overall and PFS rates were 100 and 93%, respectively. In the poor prognosis group, the 3-year overall and PFS rates were 56 and 29%, respectively. All patients with NGGCTs, in whom the lesions on MR imaging disappeared after combination therapies consisting of resection, radiation therapy, and chemotherapy, remained alive. Conclusions Chemotherapy followed by reduced-dose radiation therapy covering the whole ventricle improves the prognosis for patients with germinoma. Combined therapy of radiation therapy, chemotherapy, and radical resection as an initial or salvage treatment achieved excellent tumor control in the intermediate prognosis NGGCT group. The outcomes were still dismal in the poor prognosis NGGCT group, so initial therapy should target complete disappearance of all lesions on MR imaging.

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“…10 Therefore, the latency of recurrence in germinoma could be longer than that in the intermediate prognosis NGGCT group, and result in poorer PFS time in the long-term follow-up period.…”

Section: Treatment and Outcomes In The Germinoma Groupmentioning

confidence: 99%

Optimal treatment strategy for intracranial germ cell tumors: a single institution analysis

Kanamori¹,

Kumabe²,

Saito³

et al. 2009

PED

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“…Recurrence and dissemination of IG is seen in about 10-20% of cases within the first 2 years after the initial diagnosis [4]. The incidence of late recurrences (> 5 years) is unknown [23]. Different salvage strategies have been discussed [8].…”

Section: Discussionmentioning

confidence: 99%

“…Different salvage strategies have been discussed [8]. Platinum-based chemotherapy followed by extended-field low-dose radiotherapy has been described as effective [23,24]. Radiotherapy seems to be an important component of the management of recurrent germinoma [8].…”

Section: Discussionmentioning

confidence: 99%

Late Recurrence of a Pineal Germinoma 14 Years after Radiation and Chemotherapy: A Case Report and Review of the Literature

et al. 2013

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Background: Intracranial germinomas (IG) are rare and highly curable tumors. The incidence and optimal treatment of recurrences are not well defined. Case Report: A 34-year-old male was diagnosed with a late recurrence of an IG 14 years after the initial diagnosis and treatment. The diagnosis was complicated by the absence of tumor markers and delayed histological sampling of the lesion. Upon histological confirmation, the patient received 2 cycles of conventional chemotherapy, followed by 2 cycles of highdose chemotherapy and peripheral blood stem cell transplantation. The patient achieved a complete remission on magnetic resonance imaging scan. Consolidating radiation of the involved field was performed after termination of the chemotherapy. Conclusion: Limited information on the optimal management of late relapses of IG call for individualized therapeutic approaches. Platinum-based chemotherapy, followed by high-dose chemotherapy and consolidative radiation, appears to be feasible and effective in this situation.

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“…2 Recurrence of germinoma, particularly in the spine, is associated with a worse prognosis. 3,4 More than 80% of recurrences occur within five years. 2,5 Our patient's disease recurred after 10 years.…”

Section: Discussionmentioning

confidence: 99%

Disseminated germinoma in the brain and cervical spinal cord 10 years after radiographic resolution of pineal germinoma

Kahn

Fridley

Patel

et al. 2012

Journal of Clinical Neuroscience

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Late recurrence and salvage therapy of CNS germinomas

Cited by 44 publications

References 30 publications

Optimal treatment strategy for intracranial germ cell tumors: a single institution analysis

Optimal treatment strategy for intracranial germ cell tumors: a single institution analysis

Late Recurrence of a Pineal Germinoma 14 Years after Radiation and Chemotherapy: A Case Report and Review of the Literature

Disseminated germinoma in the brain and cervical spinal cord 10 years after radiographic resolution of pineal germinoma

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