Low-dose craniospinal irradiation as a definitive treatment for intracranial germinoma.
OBJECTIVE
To determine the optimal radiotherapy (RT) dose and volume for treatment of intracranial germinoma.


METHODS
Eighty-one intracranial germinoma patients (33 pathologically-verified; 48 presumed by radiosensitivity testing) treated with RT alone between 1971 and 2002 were analyzed. The RT volume varied from focal (13) to whole brain (8), or to the entire neuraxis (60). All the cases after 1982 received craniospinal irradiation (CSI). Radiation dose was reduced gradually during the study period from 59 to 39.3 Gy for primary tumors, and from 34.2 to 19.5 Gy for the neuraxis. The median follow-up time was 120 months (48-260 months).


RESULTS
Five- and ten-year relapse-free survival rates were 98.8% and 94.1%, respectively. All the recurrences occurred in the patients who received local (4/13) or whole brain RT (1/8). None of the patients who received CSI suffered from a recurrence. Forty-six patients received 45 Gy or less to the primary site and 22 patients received less than 20 Gy to the spinal axis.


CONCLUSIONS
Low-dose CSI-based RT should remain the standard treatment for intracranial germinoma. The RT dose can be reduced to 39.3 Gy for primary tumor sites and to 19.5 Gy for the spinal axis.
Cho
Jaeho
J
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea.
Choi
Joong-Uhn
JU
Kim
Dong-Seok
DS
Suh
Chang-Ok
CO
D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D018237:Germinoma / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D011788:Quality of Life; D011879:Radiotherapy Dosage; D015996:Survival Rate; D016896:Treatment Outcome