title: A multimodal approach including craniospinal irradiation improves the treatment outcome of high-risk intracranial nongerminomatous germ cell tumors.
abstract: OBJECTIVE
  To evaluate whether a multimodal approach including craniospinal irradiation (CSI) improves treatment outcome in nongerminomatous germ cell tumor (NGGCT) patients.
  
  
  METHODS
  We reviewed the records of 32 patients with NGGCTs. Fourteen patients belonged to the intermediate prognosis group (immature teratoma, teratoma with malignant transformation, and mixed tumors mainly composed of germinoma or teratoma), and 18 patients belonged to the poor prognosis group (other highly malignant tumors). Patients with pure germinoma or mature teratoma were excluded from this study. Nineteen patients were treated with a combination of surgery, chemotherapy, and radiotherapy (RT); 9 patients received chemotherapy plus RT; 3 patients received surgery plus RT; and 1 patient received RT alone. Twenty-seven patients received CSI with a median of 36 Gy (range, 20-41 Gy) plus focal boost of 18-30.6 Gy, and 5 patients received whole-brain RT (WBRT) (20-36 Gy) or focal RT (50.4-54 Gy). The rate of total and subtotal resection was 71.9%. The median follow-up for surviving patients was 121 months.
  
  
  RESULTS
  Treatment failed in 7 patients. Three of the 5 patients who received focal RT or WBRT had local failure. Four cerebrospinal fluid (CSF) failures occurred after CSI. No failure occurred in the intermediate prognosis group. Ten-year recurrence-free survival (RFS) and overall survival (OS) for all patients were 77.6% and 74.6%, respectively. Ten-year RFS for the intermediate and poor prognosis groups were 100% and 61.1%, respectively (p = 0.012). OS for the two groups were 85.1% and 66.7%, respectively (p = 0.215). Tumor histology and CSI were significant prognostic factors for RFS, and CSI was significantly associated with OS.
  
  
  CONCLUSIONS
  A multimodal approach was effective for treating NGGCTs. CSI should be considered for patients with poor prognostic histology.
authors.affiliation: Department of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jun Won
authors.initials: JW
authors.lastname: Kim
authors.forename: Woo Chul
authors.initials: WC
authors.lastname: Kim
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Cho
authors.forename: Dong-Seok
authors.initials: DS
authors.lastname: Kim
authors.forename: Kyu-Won
authors.initials: KW
authors.lastname: Shim
authors.forename: Chul Joo
authors.initials: CJ
authors.lastname: Lyu
authors.forename: Sung Chul
authors.initials: SC
authors.lastname: Won
authors.forename: Chang-Ok
authors.initials: CO
authors.lastname: Suh
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000134:cerebrospinal fluid / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D002822:Choriocarcinoma / Q000134:cerebrospinal fluid / Q000401:mortality / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy / Q000379:methods; D061888:Craniospinal Irradiation / Q000379:methods*; D018572:Disease-Free Survival; D018240:Endodermal Sinus Tumor / Q000134:cerebrospinal fluid / Q000401:mortality / Q000473:pathology / Q000628:therapy; D005260:Female; D018237:Germinoma / Q000134:cerebrospinal fluid / Q000401:mortality / Q000473:pathology / Q000628:therapy; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009373:Neoplasms, Germ Cell and Embryonal / Q000134:cerebrospinal fluid / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011879:Radiotherapy Dosage; D016879:Salvage Therapy / Q000379:methods / Q000401:mortality; D015996:Survival Rate; D013724:Teratoma / Q000134:cerebrospinal fluid / Q000401:mortality / Q000473:pathology / Q000628:therapy; D055815:Young Adult