Advertisement

Journal of Neuro-Oncology

, Volume 88, Issue 2, pp 161–167 | Cite as

Long term outcomes in patients with intracranial germinomas: a single institution experience of irradiation with or without chemotherapy

  • Yasuhiro Kawabata
  • Jun  A. Takahashi
  • Yoshiki Arakawa
  • Mitsuaki Shirahata
  • Nobuo Hashimoto
clinical-patient studies

Abstract

Complete remission can be achieved soon after irradiation in patients with intracranial germinoma. This study aimed to analyze the follow-up outcome of intracranial germinoma patients. About 39 intracranial germinoma patients (29 males and 10 females; average age, 15 years; range, 7–27 years) treated at Kyoto University Hospital from 1978 to 2004 were included in the study group. Six patients had multifocal disease at initial diagnosis, and 10 had human chorionic gonadotropin (HCG)-producing tumors. Thirteen patients were treated with craniospinal axis irradiation, 6 with whole-brain irradiation, 17 with whole-ventricle irradiation, and 3 with local field irradiation. Since 1997, 15 patients were treated with reduced–dose whole-ventricle irradiation (median, 23.4 Gy; range, 20.4–27 Gy) followed by a local boost (median, 40.8 Gy; range, 36–54 Gy) combined with chemotherapy. The median follow-up was 94 months (18 months to 25 years). The 5- and 10-year overall survival (OS) rates of the entire group were 97 and 90%, respectively. The 5- and 10-year progression-free survival (PFS) rates of the entire group were 91 and 87%, respectively. The 8-year OS and PFS in 15 patients treated by whole-ventricle irradiation combined with chemotherapy were 100% and 92%, respectively. Four patients had recurrences within a median period of 59.5 months (51–85 months). All relapses occurred outside the radiation fields. Tumor site, tumor size, HCG production, multifocal disease and radiation dose to the primary site or whole ventricle did not significantly affect PFS. All initial recurrences of intracranial germinoma occurred at the distant site out of the radiation field. Our data suggested that reduced doses to the whole ventricle, combined with chemotherapy, should be sufficiently effective in patients with intracranial germinoma.

Keywords

Intracranial germinoma Recurrence Radiation dose Radiation field Whole ventricle irradiation Chemotherapy Distant failure 

References

  1. 1.
    Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N, Seto T (1997) Primary intracranial germ cell tumours: a clinical analysis of 153 histologicaly verified cases. J Neurosurg 86:446–455PubMedGoogle Scholar
  2. 2.
    Sawamura Y, Ikeda J, Shirato J, Tada M, Abe H (1998) Germ cell tumours of the central nervous system: treatment consideration based on 111 cases and their long-term clinical outcomes. Eur J Cancer 34:104–110PubMedCrossRefGoogle Scholar
  3. 3.
    Haddock MG, Schild SE, Scheithauer BW, Schomberg PJ (1997) Radiation therapy for histologically combined primary central nervous system germinoma. Int J Radiat Oncol Biol Phys 38:915–923PubMedGoogle Scholar
  4. 4.
    Huh SJ, Shin KH, Kim IK, Ahn YC, Ha SW, Park CI (1996) Radiotherapy of intracranial germinomas. Radiother Oncol 38:19–23PubMedCrossRefGoogle Scholar
  5. 5.
    Ogawa K, Shikama N, Toita T, Nakamura K, Uno T, Onishi H, Itami J, Kakinohana Y, Kinjo T, Yoshi Y, Ito H, Murayama S (2004) Long-term results of radiotherapy for intracranial germinoma: a multi-institutional retrospective review of 126 patients. Int J Radiat Oncol Biol Phys 53:705–713Google Scholar
  6. 6.
    Packer RJ, Cohen BH, Coney K (2000) Intracranial germ cell tumors. Oncologist 5:312–320PubMedGoogle Scholar
  7. 7.
    Shirato H, Nishio M, Sawamura Y, Myojin M, Kitahara T, Nishioka T, Mizutani Y, Abe H, Miyasaka K (1997) Analysis of long-term treatment of intracranial germinoma. Int J Radiat Oncol Biol Phys 37:511–515PubMedGoogle Scholar
  8. 8.
    Surma-aho O, Niemelä M, Vilkki J, Kouri M, Brander A, Salonen O, Paetau A, Kallio M, Pyykkönen J, Jääskeläinen J (2001) Adverse long-term effects of brain radiotherapy in adult low-grade glioma patients. Neurology 56:1285–1290PubMedGoogle Scholar
  9. 9.
    Sutton LN, Radcliffe J, Goldwein JW, Phillips P, Janss AJ, Packer RJ, Zhao H (1999) Quality of life of adult survivors of germinomas treated with craniospinal irradiation. Neurosurgery 45:1292–1298PubMedCrossRefGoogle Scholar
  10. 10.
    Allen JC, DaRosso RC, Donahue B, Nirenberg A (1994) A Phase II trial of preirradiation carboplatin in newly diagnosed germinoma of the central nervous system. Cancer 74:940–944PubMedCrossRefGoogle Scholar
  11. 11.
    Aoyama H, Shirato H, Ikeda J, Fujieda K, Miyasaka K, Sawamura Y (2002) Induction chemotherapy followed by low-dose involved field radiotherapy for intracranial germ cell tumors. J Clin Oncol 20:857–865PubMedCrossRefGoogle Scholar
  12. 12.
    Balmaceda C, Heller G, Rosenblum M, Diez B, Villablanca JG, Kellie S, Maher P, Vlamis V, Walker RW, Leibel S, Finlay JL (1996) Chemotherapy without irradiation-A novel approach for newly diagnosed CNS germ cell tumors: results of an international cooperative trial. J Clin Oncol 14:2908–2915PubMedGoogle Scholar
  13. 13.
    Bamberg M, Kortmann R-D, Calaminus G, Becker G, Meisner C, Harms D, Göbel U (1999) Radiation therapy for intracranial germinoma: results of the German Cooperative Prospective Trial MAKEI 83/86/89. J Clin Oncol 17:2585–2592PubMedGoogle Scholar
  14. 14.
    Bouffet E, Baranzelli MC, Patte C, Portas M, Edan C, Chastagner P, Mechinaud-Lacroix F, Kalifa C (1999) Combined treatment modality for intracranial germinomas: results of a multicentre SFOP experience. Br J Cancer 79:1199–1204PubMedCrossRefGoogle Scholar
  15. 15.
    Buckner JC, Peethambaram PP, Smithson WA, Groover RV, Schomberg PJ, Kimmel DW, Raffel C, O’Fallon JR, Neglia J, Shaw EG (1999) Phase II Trial of Primary Chemotherapy Followed by Reduced-Dose Radiation for CNS Germ Cell Tumors. J Clin Oncol 17:933–940PubMedGoogle Scholar
  16. 16.
    Kellie SJ, Boyce H, Dunkel IJ, Diez B, Rosenblum M, Brualdi L, Finlay J (2004) Intensive cisplatin and cyclophosphamide-based chemotherapy without radiotherapy for intracranial germinomas: failure of a primary chemotherapy approach. Pediatr Blood Cancer 43:126–133PubMedCrossRefGoogle Scholar
  17. 17.
    Sawamura Y, Shirato H, Ikeda J, Tada M, Ishii N, Kato T, Abe H, Fujieda K (1998) Induction chemotherapy followed by reduced-volume radiation therapy for newly diagnosed central nervous system germinoma. J Neurosurg 88:66–72PubMedCrossRefGoogle Scholar
  18. 18.
    Strojan P, Zadravec LZ, Ani J, Korenjak R, Jereb B (2006) The Role of Radiotherapy in the Treatment of Childhood Intracranial Germinoma: Long-Term Survival and Late Effects. Pediatr Blood Cancer 47:77–82PubMedCrossRefGoogle Scholar
  19. 19.
    Roberge D, Kun LE, Freeman CR (2005) Intracranial Germinoma: On Whole-Ventricular Irradiation. Pediatr Blood Cancer 44:358–362PubMedCrossRefGoogle Scholar
  20. 20.
    Shibamoto Y, Sasai K, Oya N, Hiraoka M (2001) Intracranial germinoma: radiation therapy with tumor-based dose selection. Radiat Oncol 218:452–456Google Scholar
  21. 21.
    Modak S, Gardner S, Dunkel IJ, Balmaceda C, Rosenblum MK, Miller DC, Haopern S, Finlay JL (2004) Thiotepa-based high-dose chemotherapy with autologous stem-cell rescue in patients with recurrent or progressive CNS germ cell tumors. J Clin Oncol 22:1934–1943PubMedCrossRefGoogle Scholar
  22. 22.
    Silvani A, Eoli M, Salmaggi A, Lamperti E, Fariselli L, Milanesi I, Broggi G, Solero CL, Giombini S, Boiardi A (2005) Combined chemotherapy and radiotherapy for intracranial germinomas in adults patients: a single-institution study. J Neurooncol 71:271–276PubMedCrossRefGoogle Scholar
  23. 23.
    Osuka S, Tsuboi K, Takano S, Ishikawa E, Matsushita A, Tokuuye K, Akine Y, Matsumura A (2007) Long-term outcome of patients with intracranial germinoma. J Neurooncol 83:71–79PubMedCrossRefGoogle Scholar
  24. 24.
    Grau C, Overgaard J (1996) Postirradiation sensorineural hearing loss: a common but ignored late radiation complication. Int J Radiat Oncol Biol Phys 36:515–517PubMedGoogle Scholar
  25. 25.
    Nakamura H, Takeshima H, Makino K, Kochi M, Ushio Y, Kuratsu J (2006) Recurrent intracranial germinoma outside the initial radiation field: A single-institution study. Acta Oncol 45:476–483PubMedCrossRefGoogle Scholar
  26. 26.
    Schild SE, Shceithauer BW, Haddock MG, Wong WW, Lyons MK, Marks LB, Norman MG, Burger PC (1996) Histologically confirmed pineal tumors and other germ cell tumors of the brain. Cancer 78:2564–2471PubMedCrossRefGoogle Scholar
  27. 27.
    Maity A, Shu H-KG, Janss A, Belasco JB, Rorke L, Phillips PC, Sutton LN, Goldwein JW (2004) Craniospinal radiation in the treatment of biospy-proven intracranial germinomas: twenty-five years’ experience in a single center. Int J Radiat Oncol Biol Phys 58:1165–1170PubMedGoogle Scholar
  28. 28.
    Schoenfeld GO, Amdur RJ, Schmalfuss IM, Morris CG, Keole SR, Mendenhall WM, Marcus RB Jr (2006) Low-dose prophylactic cranial radiotherapy for intracranial germinoma. Int J Radiat Oncol Biol Phys 65:481–485PubMedGoogle Scholar
  29. 29.
    Nguyen QN, Chang EL, Allen PK, Maor MH, Ater JL, Mahajan A, Wolff JEA, Weinberg JS, Woo SY (2006) Focal and Craniospinal Irradiation for Patients With Intracranial Germinoma and Patterns of Failure. Cancer 107:2228–2236PubMedCrossRefGoogle Scholar
  30. 30.
    Shikama N, Toita T, Nakamura K, Uno T, Oonishi H, Ogawa K (2003) Intracranial germinoma multi-center analyses: should spinal irradiation be used for all patients? Int J Radiat Oncol Biol Phys 57(suppl 1):S370Google Scholar
  31. 31.
    Shikama N, Ogawa K, Tanaka S, Toita T, Nakamura K, Uno T, Ohnishi H, Itami J, Tada T, Saeki N (2005) Lack of benefit of spinal irradiation in the primary treatment of intracranial germinoma. Cancer 104:126–134PubMedCrossRefGoogle Scholar
  32. 32.
    Hardenbergh PH, Golden J, Billet A, Scott RM, Shrieve DC, Silver B, Loeffler JS, Tarbell NJ (1997) Intracranial germinoma: the case for lower dose radiation therapy. Int J Radiat Oncol Biol Phys 39:419–426PubMedGoogle Scholar
  33. 33.
    Wolden SL, Wara WM, Larson DA, Prados MD, Edwards MSB, Sneed PK (1995) Radiation therapy for primary intracranial germ-cell tumors. Int J Radiat Oncol Biol Phys 32:943–949PubMedGoogle Scholar
  34. 34.
    Shibamoto Y, Takahashi M, Abe M (1995) Prognosis of intracranial germinoma with syncytiotrophoblastic giant cell treated by radiation therapy. Int J Radiat Oncol Biol Phys 32(suppl. 1): 208CrossRefGoogle Scholar
  35. 35.
    Matsutani M, for the Japanese pediatric brain tumor study group (2001) Combined chemotherapy and radiation therapy for CNS germ cell tumors-the Japanese experience. J Neurooncol 54:311–316PubMedCrossRefGoogle Scholar
  36. 36.
    Merchant TE, Sherwood SH, Mulhern RK, Rose SR, Thompson SJ, Sanford RA, Kun LE (2000) CNS germinoma: disease control and long-term functional outcome for 12 children treated with craniospinal irradiation. Int J Radiat Oncol Biol Phys 46:1171–1176PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2008

Authors and Affiliations

  • Yasuhiro Kawabata
    • 1
    • 2
  • Jun  A. Takahashi
    • 1
  • Yoshiki Arakawa
    • 1
  • Mitsuaki Shirahata
    • 1
  • Nobuo Hashimoto
    • 1
  1. 1.Department of NeurosurgeryKyoto University Graduate School of MedicineSakyo-kuJapan
  2. 2.Department of NeurosurgeryHamamatsu Rosai HospitalHamamatsuJapan

Personalised recommendations