Craniospinal radiation in the treatment of biopsy-proven intracranial germinomas: twenty-five years' experience in a single center.
OBJECTIVE
The optimal treatment for intracranial germinomas remains controversial. We report on our 25-year experience using craniospinal irradiation (CSI) for this disease.


METHODS
Between September 1976 and May 2001, 39 patients with biopsy-proven intracranial germinomas seen at the Children's Hospital of Philadelphia/Hospital of the University of Pennsylvania received CSI. Thirteen of 36 patients (36%) had evidence of spinal dissemination. Median doses to the whole brain, primary site, and spine were 36 Gy (range, 18-44.2 Gy), 50.4 Gy (range, 44-55.8 Gy), and 30.6 Gy (range, 18-40 Gy), respectively.


RESULTS
With a median follow-up of 7.1 years (range: 1.5-20.2 years), there have been no documented relapses. This includes 5 patients without spinal dissemination who received 18-19.8 Gy to the craniospinal axis; for these patients, the median length of follow-up was 5.5 years (range, 1.3-6.8 years). One patient, who had no evidence of disease 12.9 years after CSI, died of unknown causes 4 months later.


CONCLUSIONS
Our treatment of intracranial germinomas with CSI has yielded outstanding results with no known relapses during a long follow-up period. These results must be considered when evaluating other approaches, such as chemotherapy only or local field irradiation.
Maity
Amit
A
Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. maity@xrt.upenn.edu
Shu
Hui-Kuo G
HK
Janss
Anna
A
Belasco
Jean B
JB
Rorke
Lucy
L
Phillips
Peter C
PC
Sutton
Leslie N
LN
Goldwein
Joel W
JW
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002648:Child; D016371:Cranial Irradiation / Q000379:methods*; D004700:Endocrine System Diseases / Q000209:etiology; D005260:Female; D018237:Germinoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006130:Growth Disorders / Q000209:etiology; D006801:Humans; D008297:Male; D011879:Radiotherapy Dosage