Radiation therapy for intracranial germ cell tumors.
OBJECTIVE
To review the combined experiences of University of California, San Francisco, and Stanford University Medical Center in the treatment of intracranial germ cell tumors (GCT) and to assess the impact of craniospinal radiation (CSI) on patterns of relapse, progression-free survival (PFS), and overall survival (OS).


METHODS
Ninety-three patients received radiation for newly diagnosed intracranial GCTs, including 49 germinomas, 16 nongerminomatous GCTs (NGGCT), and 28 with no biopsy. Median follow-up for surviving patients was 4.5 years (range 0.25-34). Tests for variables correlating with OS and PFS were conducted using Cox proportional hazards model.


RESULTS
Five-year PFS and OS rates were 60% +/- 15% and 68% +/- 14% for patients with NGGCT and 88% +/- 5% and 93% +/- 4% for those with germinoma. Of 6 patients with localized NGGCT who did not receive CSI, 1 experienced an isolated spinal recurrence but was salvaged. Of 41 patients with localized germinoma, 6 who received CSI and 35 who did not, no isolated spinal cord relapses occurred. Twenty-one patients with localized germinoma received neither CSI nor whole brain radiation. Of these, none of 18 with ventricular radiation relapsed. One of 3 patients with primary tumor radiation relapsed intracranially but had only received 11 Gy at initial treatment. On multivariate analysis, germinoma histology but not CSI correlated with improved PFS and OS.


CONCLUSIONS
CSI is not indicated in the treatment of localized germinomas. For patients with localized germinomas treated with radiation alone, we recommend ventricular irradiation followed by primary tumor boost to a total of 45-50 Gy.
Haas-Kogan
Daphne A
DA
Department of Radiation Oncology, University of California, San Francisco, CA 94143, USA. hkogan@radonc17.ucsf.edu
Missett
Brian T
BT
Wara
William M
WM
Donaldson
Sarah S
SS
Lamborn
Kathleen R
KR
Prados
Michael D
MD
Fisher
Paul G
PG
Huhn
Stephen L
SL
Fisch
Benjamin M
BM
Berger
Mitchel S
MS
Le
Quynh Thu
QT
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001706:Biopsy; D001921:Brain / Q000473:pathology; D001932:Brain Neoplasms / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D002822:Choriocarcinoma / Q000473:pathology / Q000532:radiotherapy; D015331:Cohort Studies; D016371:Cranial Irradiation; D005260:Female; D005500:Follow-Up Studies; D018237:Germinoma / Q000473:pathology / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000532:radiotherapy*; D016016:Proportional Hazards Models; D013724:Teratoma / Q000473:pathology / Q000532:radiotherapy; D016896:Treatment Outcome