Upfront chemotherapy and involved-field radiotherapy results in more relapses than extended radiotherapy for intracranial germinomas: modification in radiotherapy volume might be needed.
OBJECTIVE
To retrospectively compare the outcome of upfront chemotherapy plus radiotherapy (CRT) and the outcome of the use of extended radiotherapy (RT) only for intracranial germinoma.


METHODS
Of 81 patients with tissue-confirmed intracranial germinoma, 42 underwent CRT and 39 underwent RT only. For CRT, one to five cycles of upfront chemotherapy was followed by involved-field or extended-field RT, for which the dose was dependent on the M stage. For RT only, all 39 patients underwent craniospinal RT alone. The median follow-up was 68 months.


RESULTS
The 5- and 10-year overall survival rate was 100% and 92.5% for RT alone and 92.9% and 92.9% for CRT, respectively. The 5-year recurrence-free survival rate was 100.0% for RT and 88.1% for CRT (p = 0.0279). No recurrences developed in patients given RT, but four relapses developed in patients who had received CRT -- three in the brain and one in the spine. Only one patient achieved complete remission from salvage treatment. The proportion of patients requiring hormonal replacement was greater for patients who received RT than for those who had received CRT (p = 0.0106).


CONCLUSIONS
The results of our study have shown that the better quality of life provided by CRT was compensated for by the greater rate of relapse. The possible benefit of including the ventricles in involved-field RT after upfront chemotherapy, specifically for patients with initial negative seeding, should be addressed in a prospective study.
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Keun-Yong
KY
Eom
Il Han
IH
Kim
Charn Il
CI
Park
Hak Jae
HJ
Kim
Jin Ho
JH
Kim
Kyubo
K
Kim
Seung Ki
SK
Kim
Kyu-Chang
KC
Wang
Byung-Gyu
BG
Cho
Hee-Won
HW
Jung
Dae Seog
DS
Heo
Hyoung Jin
HJ
Kang
Hee Young
HY
Shin
Hyo Seop
HS
Ahn
D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000401:mortality* / Q000628:therapy*; D002648:Child; D004358:Drug Therapy / Q000401:mortality*; D005260:Female; D018237:Germinoma / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control*; D011878:Radiotherapy; D018714:Radiotherapy, Adjuvant / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome