title: Treatment outcomes, growth height, and neuroendocrine functions in patients with intracranial germ cell tumors treated with chemoradiation therapy.
abstract: OBJECTIVE
  We carried out a retrospective review of patients receiving chemoradiation therapy (CRT) for intracranial germ cell tumor (GCT) using a lower dose than those previously reported. To identify an optimal GCT treatment strategy, we evaluated treatment outcomes, growth height, and neuroendocrine functions.
  
  
  METHODS
  Twenty-two patients with GCT, including 4 patients with nongerminomatous GCT (NGGCT) were treated with CRT. The median age at initial diagnosis was 11.5 years (range, 6-19 years). Seventeen patients initially received whole brain irradiation (median dose, 19.8 Gy), and 5 patients, including 4 with NGGCT, received craniospinal irradiation (median dose, 30.6 Gy). The median radiation doses delivered to the primary site were 36 Gy for pure germinoma and 45 Gy for NGGCT. Seventeen patients had tumors adjacent to the hypothalamic-pituitary axis (HPA), and 5 had tumors away from the HPA.
  
  
  RESULTS
  The median follow-up time was 72 months (range, 18-203 months). The rates of both disease-free survival and overall survival were 100%. The standard deviation scores (SDSs) of final heights recorded at the last assessment tended to be lower than those at initial diagnosis. Even in all 5 patients with tumors located away from the HPA, final height SDSs decreased (p = 0.018). In 16 patients with tumors adjacent to the HPA, 8 showed metabolic changes suggestive of hypothalamic obesity and/or growth hormone deficiency, and 13 had other pituitary hormone deficiencies. In contrast, 4 of 5 patients with tumors away from the HPA did not show any neuroendocrine dysfunctions except for a tendency to short stature.
  
  
  CONCLUSIONS
  CRT for GCT using limited radiation doses resulted in excellent treatment outcomes. Even after limited radiation doses, insufficient growth height was often observed that was independent of tumor location. Our study suggests that close follow-up of neuroendocrine functions, including growth hormone, is essential for all patients with GCT.
authors.affiliation: Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan. t086016a@yokohama-cu.ac.jp
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Odagiri
authors.forename: Motoko
authors.initials: M
authors.lastname: Omura
authors.forename: Masaharu
authors.initials: M
authors.lastname: Hata
authors.forename: Noriko
authors.initials: N
authors.lastname: Aida
authors.forename: Tetsu
authors.initials: T
authors.lastname: Niwa
authors.forename: Ichiro
authors.initials: I
authors.lastname: Ogino
authors.forename: Hisato
authors.initials: H
authors.lastname: Kigasawa
authors.forename: Susumu
authors.initials: S
authors.lastname: Ito
authors.forename: Masataka
authors.initials: M
authors.lastname: Adachi
authors.forename: Tomio
authors.initials: T
authors.lastname: Inoue
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001827:Body Height; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016190:Carboplatin / Q000008:administration & dosage; D059248:Chemoradiotherapy / Q000379:methods*; D002648:Child; D016371:Cranial Irradiation / Q000379:methods; D061888:Craniospinal Irradiation / Q000379:methods; D018572:Disease-Free Survival; D004702:Endocrine Glands / Q000528:radiation effects*; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006128:Growth; D013006:Growth Hormone / Q000172:deficiency; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009765:Obesity; D010907:Pituitary Hormones / Q000172:deficiency; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014327:Trophoblasts / Q000473:pathology; D055815:Young Adult
chemical_list: D010907:Pituitary Hormones; D005047:Etoposide; D013006:Growth Hormone; D016190:Carboplatin