title: Change in treatment strategy for intracranial germinoma: long-term follow-up experience at a single institute.
abstract: BACKGROUND
  Previous intracranial germinoma (IG) studies have investigated the effect of different radiotherapy (RT) volumes and the necessity for adjunctive chemotherapy, but there is currently no consensus on the best treatment for this tumor.
  
  
  METHODS
  From January 1989 to December 2009, 80 IG patients (≤20 years old) were treated with various RT regimens. Of them, 14 patients had craniospinal irradiation (CSI) + primary boost (PB); 8 patients had whole-brain irradiation (WBI) + PB; 31 patients had whole ventricular irradiation (WVI) + PB; and 27 patients had focal RT only. Twenty-nine patients (36.2%) also received systemic chemotherapy (CHT). Survival was estimated by the Kaplan-Meier method and variables affecting survival were analyzed by the Cox proportional hazard model.
  
  
  RESULTS
  Eleven patients (13.8%) developed local recurrence or dissemination after treatment, and 10 of these patients were in the focal RT group. The 5-year relapse-free survival (RFS) for the CSI, WBI, WVI, and focal RT patients were 100%, 85.7%, 100%, and 84.6%, respectively (P = .001). The 5-year overall survival (OS) for CSI, WBI, WVI, and focal RT patients was 100%, 83.3%, 100%, and 87.9%, respectively (P = .125). Focal irradiation (P = .02) and initial use of CHT (P = .021) were negatively associated with RFS.
  
  
  CONCLUSIONS
  Focal RT plus CHT were associated with inferior control of IG and a higher incidence of CHT-related toxicities. Adjustment of the radiation volume to the whole ventricular system without CHT is sufficient for treatment of nondisseminated IGs, even with lower primary RT doses (<36 Gy).
authors: Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Yi-Wei
authors: YW
authors: Chen
authors: Pin-I
authors: PI
authors: Huang
authors: Donald Ming-Tak
authors: DM
authors: Ho
authors: Yu-Wen
authors: YW
authors: Hu
authors: Kai-Ping
authors: KP
authors: Chang
authors: Shih-Hwa
authors: SH
authors: Chiou
authors: Wan-Yuo
authors: WY
authors: Guo
authors: Feng-Chi
authors: FC
authors: Chang
authors: Muh-Lii
authors: ML
authors: Liang
authors: Yi-Yen
authors: YY
authors: Lee
authors: Hsin-Hung
authors: HH
authors: Chen
authors: Ting-Rong
authors: TR
authors: Hsu
authors: Shih-Chieh
authors: SC
authors: Lin
authors: Tai-Tong
authors: TT
authors: Wong
authors: Sang-Hue
authors: SH
authors: Yen
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000401:mortality / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation; D005260:Female; D005500:Follow-Up Studies; D018237:Germinoma / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D017211:Treatment Failure