title: SIOP CNS GCT 96: final report of outcome of a prospective, multinational nonrandomized trial for children and adults with intracranial germinoma, comparing craniospinal irradiation alone with chemotherapy followed by focal primary site irradiation for patients with localized disease.
abstract: BACKGROUND
  We conducted a nonrandomized international study for intracranial germinoma that compared chemotherapy followed by local radiotherapy with reduced-dose craniospinal irradiation (CSI) alone, to determine whether the combined treatment regimen produced equivalent outcome and avoided irradiation beyond the primary tumor site(s).
  
  
  METHODS
  Patients with localized germinoma received either CSI or 2 courses of carboplatin and etoposide alternating with etoposide and ifosfamide, followed by local radiotherapy. Metastatic patients received CSI with focal boosts to primary tumor and metastatic sites, with the option to be preceded with chemotherapy.
  
  
  RESULTS
  Patients with localized germinoma (n = 190) received either CSI alone (n = 125) or combined therapy (n = 65), demonstrating no differences in 5-year event-free or overall survival, but a difference in progression-free survival (0.97 ± 0.02 vs 0.88 ± 0.04; P = .04). Seven of 65 patients receiving combined treatment experienced relapse (6 with ventricular recurrence outside the primary radiotherapy field), and only 4 of 125 patients treated with CSI alone experienced relapse (all at the primary tumor site). Metastatic patients (n = 45) had 0.98 ± 0.023 event-free and overall survival.
  
  
  CONCLUSIONS
  Localized germinoma can be treated with reduced dose CSI alone or with chemotherapy and reduced-field radiotherapy. The pattern of relapse suggests inclusion of ventricles in the radiation field. Reduced-dose craniospinal radiation alone is effective in metastatic disease.
authors: Department of Paediatric Hematology/Oncology, University Children's Hospital, Muenster, Albert-Schweitzer Campus 1, 48149 Muenster, Germany. gabriele.calaminus@ukmuenster.de
authors: Gabriele
authors: G
authors: Calaminus
authors: Rolf
authors: R
authors: Kortmann
authors: Jennifer
authors: J
authors: Worch
authors: James C
authors: JC
authors: Nicholson
authors: Claire
authors: C
authors: Alapetite
authors: Maria Luisa
authors: ML
authors: Garrè
authors: Catherine
authors: C
authors: Patte
authors: Umberto
authors: U
authors: Ricardi
authors: Frank
authors: F
authors: Saran
authors: Didier
authors: D
authors: Frappaz
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D016190:Carboplatin / Q000008:administration & dosage; D059248:Chemoradiotherapy; D002648:Child; D002675:Child, Preschool; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D018237:Germinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D007390:International Agencies; D008297:Male; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D005047:Etoposide; D016190:Carboplatin; D007069:Ifosfamide
keywords: chemotherapy; intracranial germinoma; progression-free survival; reduced radiotherapy dose; treatment-related symptoms