Radiation Therapy for Intracranial Germinoma: Results of the German Cooperative Prospective Trials MAKEI 83/86/89

Abstract

Radiotherapy directed toward the craniospinal axis or tumor site alone at decreased dose levels is effective. To reduce the risk of late side effects, further attempts to decrease total doses are justified. In cases of recurrent disease, chemotherapy administered outside the CNS is the treatment of choice.

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

“…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]. If Patient 24 were to be excluded, the PFS for the high-risk group would be comparable at 76% (10 of 13 patients).…”

“…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].…”

“…Germ cell tumors of the brain include pure germinomas, which may be successfully treated in 85-100% of patients with radiation therapy, and the more diverse nongerminomatous germ cell tumors, which tend to recur after standard radiation (20-45% reported 5-year survivals) [1][2][3][4][5]. The biologic disparity between pure germinomas and nongerminomatous tumors is also supported by the difference in mean age at diagnosis (adolescent versus middle school years), with nongerminomatous tumors having a more heterogeneous appearance with spread to distant structures [1][2][3][4][5].…”

“…The biologic disparity between pure germinomas and nongerminomatous tumors is also supported by the difference in mean age at diagnosis (adolescent versus middle school years), with nongerminomatous tumors having a more heterogeneous appearance with spread to distant structures [1][2][3][4][5]. With the goal of reducing potential late sequelae of cranial radiation [6][7][8][9][10][11], platinum-based regimens have sought to decrease radiation dose by administering chemotherapy before reduced radiation [12][13][14][15][16].…”

Molecular genetic analysis of central nervous system germ cell tumors with comparative genomic hybridization

“…36 Recently, this success has been translated to the treatment of CNS-germinomas and, to a lesser extent, to nongerminomatous germ cell tumors. 2,[37][38][39][40][41] To a certain degree, the less favorable prognosis of CNS-GCTs that secrete alpha fetoprotein or human chorionic gonadotrophin (embryonal carcinoma, yolk sac tumor, choriocarcinoma) compared to secreting germ cell tumor at other sites might be related to anatomic problems that interfere with surgical resection. Nevertheless, it remains possible that specific biologic aspects of CNS-GCTs may additionally contribute to the poorer prognosis compared to malignant germ cell tumors at other sites.…”