title: Successful treatment of intracranial nongerminomatous malignant germ cell tumors by administering neoadjuvant chemotherapy and radiotherapy before excision of residual tumors.
abstract: OBJECTIVE
  The goal of this study was to confirm the effectiveness of our novel treatment strategy, neoadjuvant therapy (NAT) consisting of combined chemo- and radiotherapy, which are performed before complete excision of residual tumor in patients with intracranial nongerminomatous malignant germ cell tumors (NGMGCTs).
  
  
  METHODS
  The authors treated 11 consecutive patients with NGMGCTs by applying NAT consisting of combined platinum-based chemotherapy and radiotherapy, followed by complete excision of residual tumors. The pretreatment diagnosis, based on tumor markers with or without biopsy, was yolk sac tumor in five patients, embryonal carcinoma in one patient, immature teratoma in one patient, and mixed germ cell tumor containing malignant tumor components in four patients. Among the 11 patients, NAT achieved a complete response in two and a partial response in six patients; two patients manifested no change and one suffered disease progression. Residual tumors that occurred post-NAT were surgically removed in nine patients. Of the 11 patients, 10 are currently alive without recurrence of their disease, 30 to 177 months (mean 96 months) after diagnosis. In one patient a leptomeningeal tumor recurred and he died of the disease 21 months after diagnosis.
  
  
  CONCLUSIONS
  Neoadjuvant therapy, consisting of combined chemo- and radiotherapy, followed by complete excision of residual tumors is highly effective in patients with intracranial NGMGCTs.
authors.affiliation: Department of Neurosurgery, Kumamoto University Medical School, Kumamoto, Japan. kochim@kaiju.medic.kumamoto-u.ac.jp
authors.forename: Masato
authors.initials: M
authors.lastname: Kochi
authors.forename: Youichi
authors.initials: Y
authors.lastname: Itoyama
authors.forename: Shoji
authors.initials: S
authors.lastname: Shiraishi
authors.forename: Isao
authors.initials: I
authors.lastname: Kitamura
authors.forename: Toru
authors.initials: T
authors.lastname: Marubayashi
authors.forename: Yukitaka
authors.initials: Y
authors.lastname: Ushio
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D014408:Biomarkers, Tumor; D001706:Biopsy; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D002277:Carcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D002648:Child; D003131:Combined Modality Therapy; D018450:Disease Progression; D004334:Drug Administration Schedule; D018240:Endodermal Sinus Tumor / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D018237:Germinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D020360:Neoadjuvant Therapy / Q000379:methods*; D018365:Neoplasm, Residual / Q000473:pathology / Q000601:surgery; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D011182:Postoperative Care; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor