title: Chemotherapy without irradiation--a novel approach for newly diagnosed CNS germ cell tumors: results of an international cooperative trial. The First International Central Nervous System Germ Cell Tumor Study.
abstract: OBJECTIVE
  Radiation therapy for CNS germ cell tumors (GCT) is commonly associated with neurologic sequelae. We designed a therapeutic trial to determine whether irradiation could be avoided.
  
  
  METHODS
  Patients received four cycles of carboplatin, etoposide, and bleomycin. Those with a complete response (CR) received two further cycles; others received two cycles intensified by cyclophosphamide.
  
  
  RESULTS
  Seventy-one patients were enrolled (45 with germinoma and 26 with nongerminomatous GCT [NGGCT]). Sixty-eight were assessable for response. Thirty-nine of 68 (57%) achieved a CR within four cycles. Of 29 patients with less than a CR, 16 achieved CR with intensified chemotherapy or second surgery. Overall, 55 of 71 (78%) achieved a CR without irradiation. The CR rate was 84% for germinomas and 78% for NGGCT. With a median follow-up duration of 31 months, 28 of 71 patients were alive without relapse or progression. Thirty-five showed tumor recurrence (n = 28) or progression (n = 7) at a median of 13 months. Twenty-six of 28 patients (93%) who recurred following remission underwent successful salvage therapy. Pathology was the only variable predictive of survival. The probability of surviving 2 years was .84 for germinoma patients and .62 for NGGCT. Seven of 71 patients died of toxicity associated with study chemotherapy.
  
  
  CONCLUSIONS
  Forty-one percent of surviving patients and 50% of all patients were treated successfully with chemotherapy only without irradiation. Chemotherapy-only regimens for CNS GCT, although encouraging, should continue to be used only in the setting of formal clinical trials.
authors.affiliation: Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. Finlayj@mskcc.org
authors.forename: C
authors.initials: C
authors.lastname: Balmaceda
authors.forename: G
authors.initials: G
authors.lastname: Heller
authors.forename: M
authors.initials: M
authors.lastname: Rosenblum
authors.forename: B
authors.initials: B
authors.lastname: Diez
authors.forename: J G
authors.initials: JG
authors.lastname: Villablanca
authors.forename: S
authors.initials: S
authors.lastname: Kellie
authors.forename: P
authors.initials: P
authors.lastname: Maher
authors.forename: V
authors.initials: V
authors.lastname: Vlamis
authors.forename: R W
authors.initials: RW
authors.lastname: Walker
authors.forename: S
authors.initials: S
authors.lastname: Leibel
authors.forename: J L
authors.initials: JL
authors.lastname: Finlay
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D016190:Carboplatin / Q000008:administration & dosage; D016543:Central Nervous System Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D018237:Germinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D006801:Humans; D007223:Infant; D008297:Male; D015996:Survival Rate
chemical_list: D001761:Bleomycin; D005047:Etoposide; D003520:Cyclophosphamide; D016190:Carboplatin