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

Abstract

Background-This Phase II study was designed to determine response to chemotherapy and survival after response-based radiation (RT) in children with CNS germ cell tumors.

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

“…The optimal treatment of IG is still a matter of debate [13,14]. Over the last decades, patients with localized IG received chemotherapy, followed by radiotherapy [15,16,17]. Platinum-based chemotherapy has been shown to be effective, yielding a CR rate of 85-100% [18,19], but increased recurrence rates after chemotherapy alone have been reported [20,21].…”

Malignant Brain Tumors in Childhood

“…The use of CT alone has been associated with unacceptable recurrence and mortality rates for GCTs (83). For NGGCTs, RT alone has achieved disease control in only 20-45% of tumors, and combined modality therapy, also including CT and potential surgical resection, is standard (75,76,78).…”

“…There is no known advantage to achieving a GTR for pure germinomas. However, a benefit of surgical resection for NGGCT has been suggested even if it is somewhat controversial (78,81,82). Some series have shown a trend toward improved control with more aggressive resection for malignant histiotypes.…”

“…Unfortunately, this trial closed due to poor accrual leaving this important question unanswered. For NGGCTs, combined CT and RT is the standard, again with some uncertainty regarding the appropriate radiation volume: local, whole ventricle, whole brain, or CSI (78,79). The use of stereotactic radiosurgery to boost local disease visible on imaging after and persistent after CT and fractionated RT is rational, but investigational for children with persistent NGGCT that cannot be safely removed by S (88).…”

“…Several series using pre irradiation CT and limited-volume, "response-adjusted" attenuation of radiation doses has shown excellent disease control rates. Initially explored in the United States by Allen with the use of cyclophosphamide and, later, platinating agents, this treatment has resulted in a large proportion of complete or substantial responses, with long-term disease control after local irradiation to reduced dose levels of 24-36 Gy (78,86,89). Carboplatin, most often in combination with etoposide, has replaced cisplatin for germinomas because the drug is associated with fewer long-term sequelae (90).…”