title: Late recurrence and salvage therapy of CNS germinomas.
abstract: Central nervous system (CNS) germinoma is a curable tumor and its recurrence rate after initial therapy may be approximately 10% or higher. This study elucidates the time-course of recurrence and results of salvage therapy. Twenty-five patients with recurrent germinoma treated at Hokkaido University Hospital were retrospectively reviewed. The median age at initial treatment was 12 years (range: 8-37). All patients had been tumor-free for at least 6 months after the initial treatment. The median follow-up period was 134 months (range: 44-338). The median age at first recurrence was 18 years and the median time to the first recurrence was 50 months. Among the patients, 9 (36%) had the first recurrence at 60 months or later. The latest recurrence in a patient occurred 230 months after the initial treatment. The results of salvage therapy were estimated in all 25 patients. Seventeen patients (68%) were salvaged and were tumor-free at the final observation. The remaining 8 patients died of disease. At first recurrence, 11 patients were treated using radiation therapy with or without surgery and 7 out of the 11 patients died due to the recurrent tumor. On the other hand, 13 patients who received salvage chemotherapy and radiotherapy were tumor-free at the last follow-up. In conclusion, late recurrence is not a rare event in patients with CNS germinoma. To identify a true cure rate of this disease, a 10-year or longer observation period may be required. As a salvage therapy, platinum-based chemotherapy followed by wide-field low-dose radiation therapy appears to be effective.
authors.affiliation: Department of Neurosurgery, Hokkaido University Hospital, North-15, West-7, Kita-ku, Sapporo 060-8638, Japan. kamoshima2002@yahoo.co.jp
authors.forename: Yuuta
authors.initials: Y
authors.lastname: Kamoshima
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sawamura
authors.forename: Jun
authors.initials: J
authors.lastname: Ikeda
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shirato
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Aoyama
mesh_terms: D000293:Adolescent; D000328:Adult; D016543:Central Nervous System Neoplasms / Q000401:mortality / Q000517:prevention & control*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D018237:Germinoma / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D008297:Male; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D055502:Secondary Prevention; D013997:Time Factors; D055815:Young Adult