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.
Yen
Sang-Hue
SH
Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan. rjalali@tmc.gov.in
Chen
Yi-Wei
YW
Huang
Pin-I
PI
Wong
Tai-Tong
TT
Ho
Donald Ming-Tak
DM
Chang
Kai-Ping
KP
Liang
Muh-Lii
ML
Chiou
Shih-Hwa
SH
Lee
Yi-Yen
YY
Chen
Hsin-Hung
HH
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