Proton Beam Therapy for Loco-Regional Control of a Recurrent Mixed Malignant Germ Cell Tumor of the Skull in a 22-Month-Old Girl

Abstract PURPOSE To evaluate the clinical outcome of patients with intracranial germ cell tumor treated with proton beam therapy (PBT). MATERIALS AND METHODS Fifty-seven patients with intracranial germ cell tumor treated with PBT between 2009 and 2016 were retrospectively analyzed. RESULTS Median follow-up duration was 63.7 months (range, 5.6–204.5). Thirty-seven patients (64.9%) were pure germinoma and 20 patients (35.1%) were non-germinomatous germ cell tumor (NGGCT). All patients except 2 patients received chemotherapy before PBT. Twenty-one patients (36.8%) of localized germinoma were treated with whole ventricle irradiation (WVI), while 36 (63.2%) patients who were diagnosed as disseminated germinoma or NGGCT received cranio-spinal irradiation (CSI). Two patients with pure germinoma in basal ganglia showed disease relapse at 3.0 and 6.9 years after PBT at the primary site and pituitary gland, respectively. There was one patient with NGGCT who died of chemotherapy-related mortality at 4.7 years after PBT while her disease was complete remission. The 7-year progression-free survival and overall survival were 70.8% and 100% for focal germinoma, 100% and 100% for disseminated germinoma, 100% and 100% for focal NGGCTs, and 100% and 80.0% for disseminated NGGCTs, respectively. CONCLUSIONS PBT of pure germinoma resulted in comparable clinical outcomes to that with photon radiotherapy. Our result for NGGCT is also excellent compared to other reports. Failure patterns of germ cell tumors originating in basal ganglia needs to be assessed in large pooled data.

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Prognostic Impact of Lymphadenectomy in Different Stages of Malignant Germ Cell Tumor of the Ovary Based on Propensity Score Matching

Combinatorial Chemistry & High Throughput Screening ◽

10.2174/1386207322666181220121836 ◽

2019 ◽

Vol 21 (9) ◽

pp. 652-661 ◽

Cited By ~ 2

Author(s):

Ying Chen ◽

Yang Ning ◽

Qinghua Zhang ◽

Ying Xie

Keyword(s):

Lymph Node ◽

Propensity Score ◽

Germ Cell ◽

Propensity Score Matching ◽

Germ Cell Tumor ◽

Cell Tumor ◽

Stage I ◽

Prognostic Impact ◽

Lymph Node Resection ◽

Malignant Germ Cell Tumor

Background: Lymphadenectomy has been widely used in the treatment of malignant germ cell tumor of the ovary (OGCT), which is a kind of ovarian cancers occurred mostly in young women and adolescent girls. But the clinical decision mainly depends on the doctor’s experience without a well-defined guideline. This population-based study aimed to evaluate the prognostic impact of lymphadenectomy in different stages of malignant germ cell tumors of the ovary. Methods: Patients with known status of lymphadenectomy in different stages of OGCT were explored from the Surveillance, Epidemiology, and End Results (SEER) program database from 1973 to 2013. We used propensity score matching algorithm to reduce the selection bias between the two study groups. Survival curves, univariate and multivariate Cox proportional hazards model were applied to evaluate the prognostic impact of lymphadenectomy in different stages of OGCT. Results: We included 1,996 OGCT patients in the study, and 818 (41%) of them had lymph node resection. Compared to the LND- group, patients with lymph node resection tended to be at stage II and III, had larger tumor sizes and diagnosed as dysgerminoma. The influence of diagnosis ages, marital status and tumor grades were significantly decreased by applying the propensity score matching. Lymphadenectomy-positive (LND+) group demonstrated significantly worse survival than the lymphadenectomy-negative (LND-) group in later stages (stage III, overall, P=0.027, cancerspecific, P=0.006; stage IV, overall, P=0.034, cancer-specific, P=0.037). While, both the overall and cancer-specific survival showed no significant differences between LND+ and LND- in stage I (overall, P=0.411, cancer-specific, P=0.876) and stage II (overall, P=12, cancer-specific, P=0.061). Univariate (overall, HR=1.497, CI=1.010-2.217, P=0.044; cancer-specific, HR=1.524, CI=1.067- 2.404, P=0.050) and multivariate (overall, HR=1.580, CI=1.046-2.387, P=0.030; cancer-specific, HR=1.661, CI=1.027-2.686, P=0.039) Cox proportional model both verified the association between the lymph node resection and better survival in the whole cohort. Conclusion: Lymphadenectomy significantly increased the survival probability of OGCT patients in stage III and IV, but had no significant influence on early-stage patients (stage I and II), indicating lymphadenectomy should be performed in a stage-dependent manner in clinical utility.

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