Optimal treatment for intracranial germinoma: can we lower radiation dose without chemotherapy?
OBJECTIVE
To review the effectiveness of reduced-dose and restricted-volume radiation-only therapy in the treatment of intracranial germinoma and to assess the feasibility of reducing or eliminating the use of chemotherapy.


METHODS
Between January 1996 and March 2007, a retrospective analysis was performed that included 38 patients who received either reduced radiation alone (30 Gy for 26 patients) or reduced radiation with chemotherapy (n = 12 patients). All 38 patients received extended focal (including whole-ventricle) irradiation and were followed up until February 2008. Overall survival (OS) and relapse-free survival (RFS) rates were calculated. Variables associated with survival were evaluated by univariate Cox proportional hazards regression.


RESULTS
Median follow-up was 62.4 months (range, 10.1-142.5 months). The total 5-year OS rate was 93.7%. The 5-year OS and RFS rates for patients receiving radiation only were 100% and 96.2%, respectively. The rates for those receiving radiation plus chemotherapy were 83.3 % and 91.7%, respectively (not statistically significant). No predictive factor was significantly associated with the OS or RFS rate. Chemotherapy had no significant effect on survival but was associated with a higher incidence of treatment-related toxicity.


CONCLUSIONS
A further decrease in the radiation dose to 30 Gy with whole-ventricle irradiation is sufficient to treat selected patients with intracranial germinoma. Wide-field irradiation or chemotherapy should be avoided as these methods are unnecessary. Thus, reduction of the radiation dose to 30 Gy may be feasible, even without chemotherapy.
Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan. rjalali@tmc.gov.in
Sang-Hue
SH
Yen
Yi-Wei
YW
Chen
Pin-I
PI
Huang
Tai-Tong
TT
Wong
Donald Ming-Tak
DM
Ho
Kai-Ping
KP
Chang
Muh-Lii
ML
Liang
Shih-Hwa
SH
Chiou
Yi-Yen
YY
Lee
Hsin-Hung
HH
Chen
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D002648:Child; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D005240:Feasibility Studies; D018237:Germinoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D017567:Karnofsky Performance Status; D011379:Prognosis; D011829:Radiation Dosage; D011878:Radiotherapy / Q000009:adverse effects; D012044:Regression Analysis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
D000970:Antineoplastic Agents