Long-term neuroanatomical effects of germ cell tumors after cranial radiation therapy

Abstract BACKGROUND Intracranial germ cell tumors (GCT) are mainly arising in adolescent term and treated with chemotherapy concomitant with radiation therapy. There is accumulating evidence that the progress of treatment. Besides, long-term outcome and adverse effects are major problem in treatment. So, we must grasp the influence of these outcomes on daily and social life. Then we investigated in clinical outcome in cases of GCT treated in our institution. METHOD: We reviewed the clinical features and outcomes of 52 cases of intracranial GCT in 1975 to 2019. Ages on diagnosis are 5–35 years old (median 14 years old), consisted with 44 male cases. The pathological distributions are these: pure germinoma: 40 cases, non-germinomatous germ cell tumor (NGGCT): 10 cases (mature teratoma: 4, mixed germ cell tumors: 3, and one cases of choriocarcinoma, embryonal carcinoma, yolk sac tumor), unidentified pathology: 2 cases. Almost all cases have biopsied and treated by chemotherapy and radiation therapy. RESULTS Chemotherapy with ICE regimen (ifosphamide, cisplatin, etoposide) or CARE regimen (carboplatin, etoposide) concomitant with radiation therapy (mainly, extended local irradiation) have done in almost cases by the era. Clinical outcomes are relatively well in our cases, but 10 cases experienced recurrence. 3 cases have dead. Some cases with suprasellar involvement have need hormone replacement in long term. There are 10 cases at work. CONCLUSION Almost cases have gained better outcome and ADL. But there is slightly lower rate in work or marriage. Serial evaluation in outcome, and higher brain functions should be performed in follow up.

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Phase II Trial of Primary Chemotherapy Followed by Reduced-Dose Radiation for CNS Germ Cell Tumors

Journal of Clinical Oncology ◽

10.1200/jco.1999.17.3.933 ◽

1999 ◽

Vol 17 (3) ◽

pp. 933-933 ◽

Cited By ~ 116

Author(s):

Jan C. Buckner ◽

Prema P. Peethambaram ◽

William A. Smithson ◽

Robert V. Groover ◽

Paula J. Schomberg ◽

...

Keyword(s):

Radiation Therapy ◽

Germ Cell ◽

Phase Ii ◽

Tumor Regression ◽

Germ Cell Tumors ◽

Progression Free Survival ◽

Complete Regression ◽

Conventional Dose ◽

Response To Chemotherapy

PURPOSE: A prospective phase II study was initiated to assess the response rate, survival, and late effects of treatment in patients with newly diagnosed CNS germ cell tumors (GCT), using etoposide plus cisplatin followed by radiation therapy prescribed by extent of disease, histology, and response to chemotherapy. PATIENTS AND METHODS: Seventeen patients aged 8 to 24 years with histologically proven CNS GCT received etoposide (100 mg/m2/d) plus cisplatin (20 mg/m2/d) daily for 5 days every 3 weeks for four cycles, followed by radiation therapy. Nine patients had germinomas; eight had mixed GCT. Four patients (three with germinomas and one with mixed GCT) presented with leptomeningeal dissemination. RESULTS: Radiographically, 14 of 17 patients were assessable for response; 11 patients experienced complete regression, and three had major partial regression before radiation. Six of seven assessable patients with elevated CSF levels of alpha-fetoprotein or beta–human chorionic gonadotropin had normalization with chemotherapy alone; all normalized with combined chemotherapy and radiation therapy. All 17 patients are alive without evidence of disease (median follow-up, 51 months). One patient developed a relapse in the spinal leptomeninges and was rendered free of disease with spinal radiation more than 5 years ago. One patient developed carotid stenosis requiring surgery. Thus far, only minimal long-term deterioration in neurocognitive function has been detected as a consequence of protocol treatment. CONCLUSION: Conventional-dose intravenous chemotherapy with etoposide and cisplatin can effect tumor regression in a high proportion of patients with CNS GCT, including those with leptomeningeal metastases. Acute and long-term toxicities are acceptable. Progression-free survival and overall survival are excellent.

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Treatment outcome and long-term follow-up of central nervous system germ cell tumor using upfront chemotherapy with subsequent photon or proton radiation therapy: a single tertiary center experience of 127 patients

BMC Cancer ◽

10.1186/s12885-020-07484-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Kyung Taek Hong ◽

Da Hye Lee ◽

Bo Kyung Kim ◽

Hong Yul An ◽

Jung Yoon Choi ◽

...

Keyword(s):

Central Nervous System ◽

Radiation Therapy ◽

Germ Cell ◽

Germ Cell Tumors ◽

Secondary Malignancy ◽

Proton Radiation ◽

Proton Radiation Therapy ◽

Long Term Follow Up

Abstract Background Central nervous system germ cell tumors (CNS GCTs) are a heterogeneous group of brain tumors, which are more common in Asian countries. There have been different therapeutic strategies in treating germinoma and non-germinomatous germ cell tumors (NGGCT), depending on prognosis. Moreover, long-term follow up should be emphasized due to higher late complication rates. Here, we investigated long-term outcomes and complication profiles of 127 CNS GCT patients who received uniform upfront chemotherapy. Methods We retrospectively evaluated outcomes of CNS GCT patients treated in Seoul National University Children’s Hospital from August 2004 to April 2019. Patients were classified as low risk (LR) or high risk (HR) based on pathologic diagnosis and tumor markers. Most patients received upfront systemic chemotherapy with carboplatin, cyclophosphamide, etoposide, and/or bleomycin, followed by either proton or photon radiation therapy according to patients’ choice. Results The median age at diagnosis was 11.9 (range, 3.8–25.1) years, and 54.3% of patients were LR. Photon and proton radiation therapy were administered to 73.2 and 25.2% of patients, respectively. In both LR and HR groups, there were no significant differences in survival between photon and proton radiation therapy. The 10-year relapse incidences were 9.3 and 5.6% in the LR and HR groups, respectively. All recurrences, except one, were local relapse. Six secondary malignancies occurred; the 10-year incidences of secondary malignancy were 2.2 and 7.6% in the LR and HR groups, respectively. The 10-year overall survival rates were 98.3 ± 1.7 and 91.8 ± 3.9% in the LR and HR groups, respectively. In a subgroup analysis of HR group, pathologically diagnosed NGGCT patients (n = 20) showed worse 10-year EFS (65.9 ± 11.9%, p < 0.001) and OS (77.9 ± 9.8%, p = 0.024) rates compared to other HR patients who were not pathologically diagnosed or were confirmed as germinoma with elevated tumor markers. All mortalities were related to disease progression or secondary malignancy. Conclusion The strategy of treating CNS GCTs with upfront chemotherapy according to risk groups resulted in good clinical outcomes and acceptable relapse incidence. However, further modification in the definition of the HR group is needed to reduce long-term complications.

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Adjuvant therapy of ovarian germ cell tumors with cisplatin, etoposide, and bleomycin: a trial of the Gynecologic Oncology Group.

Journal of Clinical Oncology ◽

10.1200/jco.1994.12.4.701 ◽

1994 ◽

Vol 12 (4) ◽

pp. 701-706 ◽

Cited By ~ 224

Author(s):

S Williams ◽

J A Blessing ◽

S Y Liao ◽

H Ball ◽

P Hanjani

Keyword(s):

Germ Cell ◽

Gynecologic Oncology ◽

Cell Cancer ◽

Germ Cell Tumors ◽

Germ Cell Cancer ◽

Gynecologic Oncology Group ◽

Long Term Follow Up ◽

Acute Myelomonocytic Leukemia

PURPOSE This study was performed to determine the effectiveness of postoperative adjuvant chemotherapy in patients with surgically resected ovarian germ cell tumors. PATIENTS AND METHODS After tumor removal and thorough surgical staging, patients were enrolled on this study and treated with three courses of cisplatin, etoposide, and bleomycin (BEP). Reassessment laparotomy was required of consenting, appropriate patients initially, but became an optional procedure in 1989. RESULTS Of 93 patients assessable on this trial, 89 are continuously free of germ cell cancer. At second-look laparotomy, two other patients were found to have small foci of immature teratoma; both remain clinically free of recurrence. One received subsequent alternate chemotherapy and one did not. Thus, 91 of 93 patients are currently free of germ cell cancer. Follow-up duration ranges from 4.0 to 90.3 months, with 67 patients monitored for longer than 2 years. Acute toxicity was moderate. One patient developed acute myelomonocytic leukemia 22 months after diagnosis. Another patient was noted to have a malignant lymphoma 69 months after protocol treatment. CONCLUSION Three courses of BEP will nearly always prevent recurrence in well-staged patients with completely resected ovarian germ cell tumors and should be given to all such patients. The development of acute leukemia as a complication of treatment is disturbing and mandates careful long-term follow-up, but is unusual and does not alter the risk-to-benefit ratio of treatment.

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