title: Salvage treatment for recurrent intracranial germinoma after reduced-volume radiotherapy: a single-institution experience and review of the literature.
abstract: OBJECTIVE
  Intracranial germinomas (IGs) are highly curable with radiotherapy (RT). However, recurrence still occurs, especially when limited-field RT is applied, and the optimal salvage therapy remains controversial.
  
  
  METHODS
  Between January 1989 and December 2010, 14 patients with clinically or pathologically diagnosed recurrent IGs after RT were reviewed at our institution. Of these, 11 received focal-field RT, and the other 3 received whole-brain irradiation, whole-ventricle irradiation, and Gamma Knife radiosurgery as the respective first course of RT. In addition, we identified from the literature 88 patients with recurrent IGs after reduced-volume RT, in whom the details of salvage therapy were recorded.
  
  
  RESULTS
  The median time to recurrence was 30.3 months (range, 3.8-134.9 months). One patient did not receive further treatment and was lost during follow-up. Of the patients, 7 underwent salvage with craniospinal irradiation (CSI) plus chemotherapy (CT), 4 with CSI alone, 1 with whole-brain irradiation plus CT, and 1 with Gamma Knife radiosurgery. The median follow-up time was 105.1 months (range, 24.2-180.9 months). Three patients died without evidence of disease progression: two from second malignancies and one from unknown cause. The others remained disease free. The 3-year survival rate after recurrence was 83.3%. A total of 102 patients from our study and the literature review were analyzed to determine the factors affecting prognosis and outcomes. After recurrence, the 5-year survival rates were 71% and 92.9% for all patients and for those receiving salvage CSI, respectively. Univariate analysis showed that initial RT volume, initial RT dose, initial CT, and salvage RT type were significant prognostic predictors of survival. On multivariable analysis, salvage CSI was the most significant factor (p = 0.03).
  
  
  CONCLUSIONS
  Protracted follow-up is recommended because late recurrence is not uncommon. CSI with or without CT is an effective salvage treatment for recurrence after reduced-volume RT.
authors.affiliation: Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Hu
authors.forename: Pin-I
authors.initials: PI
authors.lastname: Huang
authors.forename: Tai-Tong
authors.initials: TT
authors.lastname: Wong
authors.forename: Donald Ming-Tak
authors.initials: DM
authors.lastname: Ho
authors.forename: Kai-Ping
authors.initials: KP
authors.lastname: Chang
authors.forename: Wan-Yuo
authors.initials: WY
authors.lastname: Guo
authors.forename: Feng-Chi
authors.initials: FC
authors.lastname: Chang
authors.forename: Cheng-Yin
authors.initials: CY
authors.lastname: Shiau
authors.forename: Muh-Lii
authors.initials: ML
authors.lastname: Liang
authors.forename: Yi-Yen
authors.initials: YY
authors.lastname: Lee
authors.forename: Hsin-Hung
authors.initials: HH
authors.lastname: Chen
authors.forename: Sang-Hue
authors.initials: SH
authors.lastname: Yen
authors.forename: Yi-Wei
authors.initials: YW
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D002648:Child; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D016371:Cranial Irradiation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D018237:Germinoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D015292:Glycoprotein Hormones, alpha Subunit / Q000097:blood; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D016634:Radiosurgery / Q000379:methods; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D055815:Young Adult
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D015292:Glycoprotein Hormones, alpha Subunit