title: Low-dose prophylactic craniospinal radiotherapy for intracranial germinoma.
abstract: OBJECTIVE
  To report outcomes of patients with localized intracranial germinoma treated with low-dose craniospinal irradiation (CSI) followed by a boost to the ventricular system and primary site.
  
  
  METHODS
  Thirty-one patients had pathologically confirmed intracranial germinoma and no spine metastases. Low-dose CSI was administered in 29 patients: usually 21 Gy of CSI, 9.0 Gy of ventricular boost, and a 19.5-Gy tumor boost, all at 1.5 Gy per fraction. Our neuroradiologist recorded three-dimensional tumor size on magnetic resonance images before, during, and after radiotherapy.
  
  
  RESULTS
  With a median follow-up of 7.0 years, 29 of 31 patients (94%) are disease free. One failure had nongerminomatous histology; the initial diagnosis was a sampling error. Of 3 patients who did not receive CSI, 1 died. No patient developed myelopathy, visual deficits, dementia, or skeletal growth problems. In locally controlled patients, tumor response according to magnetic resonance scan was nearly complete within 6 months after radiotherapy.
  
  
  CONCLUSIONS
  Radiotherapy alone with low-dose prophylactic CSI cures almost all patients with localized intracranial germinoma. Complications are rare when the daily dose of radiotherapy is limited to 1.5 Gy and the total CSI dose to 21 Gy. Patients without a near-complete response to radiotherapy should undergo resection to rule out a nongerminomatous element.
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida 32610-0385, USA.
authors.forename: Gordon O
authors.initials: GO
authors.lastname: Schoenfeld
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Amdur
authors.forename: Ilona M
authors.initials: IM
authors.lastname: Schmalfuss
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
authors.forename: Sameer R
authors.initials: SR
authors.lastname: Keole
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall
authors.forename: Robert B
authors.initials: RB
authors.lastname: Marcus
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D002648:Child; D016371:Cranial Irradiation / Q000379:methods*; D003951:Diagnostic Errors; D005260:Female; D005500:Follow-Up Studies; D018237:Germinoma / Q000532:radiotherapy* / Q000556:secondary; D006801:Humans; D008297:Male; D011879:Radiotherapy Dosage; D013724:Teratoma / Q000473:pathology / Q000532:radiotherapy