SIOP CNS GCT 96: Final report of outcome of a prospective, multinational nonrandomized trial for children and adults with intracranial germinoma, comparing craniospinal irradiation alone with chemotherapy followed by focal primary site irradiation for patients with localized disease

Gabriele Calaminus, Rolf Kortmann, Jennifer Worch, James C. Nicholson, Claire Alapetite, Maria Luisa Garrè, Catherine Patte, Umberto Ricardi, Frank Saran, Didier Frappaz

Research output: Contribution to journalArticlepeer-review

Abstract

BackgroundWe conducted a nonrandomized international study for intracranial germinoma that compared chemotherapy followed by local radiotherapy with reduced-dose craniospinal irradiation (CSI) alone, to determine whether the combined treatment regimen produced equivalent outcome and avoided irradiation beyond the primary tumor site(s).MethodsPatients with localized germinoma received either CSI or 2 courses of carboplatin and etoposide alternating with etoposide and ifosfamide, followed by local radiotherapy. Metastatic patients received CSI with focal boosts to primary tumor and metastatic sites, with the option to be preceded with chemotherapy.ResultsPatients with localized germinoma (n = 190) received either CSI alone (n = 125) or combined therapy (n = 65), demonstrating no differences in 5-year event-free or overall survival, but a difference in progression-free survival (0.97 ± 0.02 vs 0.88 ± 0.04; P =. 04). Seven of 65 patients receiving combined treatment experienced relapse (6 with ventricular recurrence outside the primary radiotherapy field), and only 4 of 125 patients treated with CSI alone experienced relapse (all at the primary tumor site). Metastatic patients (n = 45) had 0.98 ± 0.023 event-free and overall survival.ConclusionsLocalized germinoma can be treated with reduced dose CSI alone or with chemotherapy and reduced-field radiotherapy. The pattern of relapse suggests inclusion of ventricles in the radiation field. Reduced-dose craniospinal radiation alone is effective in metastatic disease.

Original languageEnglish
Pages (from-to)788-796
Number of pages9
JournalNeuro-Oncology
Volume15
Issue number6
DOIs
Publication statusPublished - Jun 2013

Keywords

  • chemotherapy
  • intracranial germinoma
  • progression-free survival
  • reduced radiotherapy dose
  • treatment-related symptoms

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Clinical Neurology

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