Treatment Outcomes, Growth Height, and Neuroendocrine Functions in Patients With Intracranial Germ Cell Tumors Treated With Chemoradiation Therapy

Odagiri, Kazumasa; Omura, Motoko; Hata, Masaharu; Aida, Noriko; Niwa, Tetsu; Ogino, Ichiro; Kigasawa, Hisato; Ito, Susumu; Adachi, Masataka; Inoue, Tomio

doi:10.1016/j.ijrobp.2011.12.084

Cited by 39 publications

(32 citation statements)

References 15 publications

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“…Seventeen studies ( n = 2032 participants) reported prevalence of overweight and obesity among patients with various types of brain tumours ; The study characteristics and results are described in Table . The age at diagnosis ranged from at birth to 24.8 year old.…”

Section: Resultsmentioning

confidence: 99%

Overweight, obesity and adiposity in survivors of childhood brain tumours: a systematic review and meta‐analysis

et al. 2017

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What is already known about this study• Survivors of childhood brain tumours (SCBT) have increased cardiometabolic risks including type 2 diabetes and cardiovascular disease.• Obesity is a main driver of cardiometabolic disease in non-cancer controls.• Adiposity is a more robust measure to stratify cardiometabolic risks in non-cancer controls. What this study adds• A meta-analysis summarizing the prevalence of overweight and obesity in SCBT and compared that to non-cancer controls based on current literature.• A meta-analysis summarizing the current evidence on adiposity profile in SCBT in comparison to non-cancer controls.• Overall quality of evidence on the subject is evaluated. SummarySurvivors of childhood brain tumours (SCBT) have increased cardiometabolic risks, but the determinants of these risks are unclear. This systematic review aims to compare the prevalence of overweight and obesity as well as adiposity measures between SCBT and non-cancer controls. The PubMed, EMBASE, MEDLINE, CINAHL and the Cochrane Library databases were searched. The primary outcomes were the prevalence of overweight and obesity based on body mass index. The secondary outcomes were adiposity measures including percent fat mass, waist-to-hip and waist-to-height ratios. Forty-one studies were included in the meta-analysis. The prevalence of overweight and obesity combined was similar between overall SCBT, SCBT excluding craniopharyngioma and non-cancer controls (42.6%,. We also found that SCBT have higher percent fat mass (mean difference 4.1%, 95% CI 2.0-6.1), waist-to-hip ratio (mean difference 0.07, 95% CI 0.02-0.13) and waist-to-height ratio (mean difference 0.06, 95% CI 0.01-0.10) than non-cancer controls. We conclude that SCBT have similar overweight and obesity distribution but higher adiposity than non-cancer controls. More studies were needed to explore the determinants of adiposity and its contribution to cardiometabolic outcomes in SCBT.

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Section: Resultsmentioning

confidence: 99%

Overweight, obesity and adiposity in survivors of childhood brain tumours: a systematic review and meta‐analysis

et al. 2017

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“…In 16 patients with tumors adjacent to the pituitary hypothalamic axis, 8 showed metabolic changes suggestive of hypothalamic obesity and/or growth hormone deficiency, and 13 had other pituitary hormone deficiencies. By contrast, four of five patients with tumors away from the pituitary hypothalamic axis did not show any neuroendocrine dysfunctions [64].…”

Section: Endocrinological Disordersmentioning

confidence: 71%

“…In the majority of cases endocrinological deficits at diagnosis are prevailing over treatment-induced dysfunctions mainly when the suprasellar region is involved requiring replacement therapy [13,15,36,42,[61][62][63][64]. Data on quality of survival and neurocognitive function are retrospective in nature, based on heterogeneous cohorts of patients including non-germinoma who received more intensive treatments [13,15,19,22,36,42,63,65,67,68,70,71].…”

Section: Expert Commentarymentioning

confidence: 99%

Current concepts and future strategies in the management of intracranial germinoma

Kortmann

2014

Expert Review of Anticancer Therapy

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Radiation therapy is the backbone in the management of intracranial germinoma. In localized disease chemotherapy followed by whole brain irradiation is the present standard providing cure rates in excess of 90%. Craniospinal irradiation alone in metastatic disease provides equally excellent outcome. Chemotherapy is able to convert macroscopic to microscopic disease permitting a dose reduction to the tumor site and possibly the ventricular system and is investigated in prospective trials. Chemotherapy alone cannot replace radiotherapy as sole treatment. Whole-ventricular radiotherapy followed by a boost to tumor site without chemotherapy might be feasible. New treatment technologies such as intensity-modulated radiotherapy or proton therapy permit a dose reduction to non-target brain. Data on functional outcome are conflicting and based on small heterogeneous series only mandating prospective investigations.

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“…With modern day treatment strategies of modest chemotherapy and reduced dose and volume irradiation, long‐term neurocognitive dysfunction is rare . However, neuroendocrine dysfunction is more common and recent data have shown that even low radiation doses can result in impaired growth and final height if patients are not followed carefully and treated appropriately for growth hormone deficiency . As such, it is integral to reduce unwanted dose to normal structures when possible.…”

Section: Discussionmentioning

confidence: 99%

Intensity‐Modulated Radiation Therapy With Dose Painting: A Brain‐Sparing Technique for Intracranial Germ Cell Tumors

Yang

Terezakis

Dunkel

et al. 2015

Pediatric Blood & Cancer

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Purpose To assess patterns of failure in pediatric patients with intracranial germ cell tumors (GCT) treated with intensity-modulated radiation therapy with dose-painting (DP-IMRT). Methods Between July 2007 and October 2013, 11 patients with localized GCT, 5 germinomas and 6 non-germinoma germ cell tumors (NGGCT), received definitive treatment with DP-IMRT. Three representative patients were selected for re-planning with (1) whole ventricular irradiation (WVI) with opposed-lateral beams plus IMRT to the primary tumor and (2) sequential-IMRT. These plans were compared to the patients' original DP-IMRT plans for dosimetric analyses. Results Four patients with germinoma received RT alone: 45 Gy in 1.8 Gy fractions to the primary tumor and 25 Gy in 1.0 Gy fractions to whole ventricles using a dose-painting plan. One patient with germinoma received a reduced dose of 30.6 Gy to the primary tumor after neoadjuvant chemotherapy. Patients with NGGCT (n=6) underwent multimodality treatment including chemotherapy (n=6) and surgery (n=3). These patients received 54 Gy to the primary tumor and 32.4-36 Gy to the whole ventricles. Dosimetric analyses showed DP-IMRT delivered decreased mean dose to whole brain, temporal lobes, hippocampi, cochleae, and optic nerves. With median follow-up of 4 years, 3-year failure free survival was 100% for patients with germinoma and 67% for patients with NGGCT. One patient with a pineal NGGCT experienced a local recurrence within the high-dose volume while another experienced an isolated biochemical failure. Conclusions DP-IMRT is dosimetrically superior to standard IMRT techniques for sparing of normal tissues. Disease control in this small series appears at least comparable to published results.

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Treatment Outcomes, Growth Height, and Neuroendocrine Functions in Patients With Intracranial Germ Cell Tumors Treated With Chemoradiation Therapy

Cited by 39 publications

References 15 publications

Overweight, obesity and adiposity in survivors of childhood brain tumours: a systematic review and meta‐analysis

Overweight, obesity and adiposity in survivors of childhood brain tumours: a systematic review and meta‐analysis

Current concepts and future strategies in the management of intracranial germinoma

Intensity‐Modulated Radiation Therapy With Dose Painting: A Brain‐Sparing Technique for Intracranial Germ Cell Tumors

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