Intensive chemotherapy followed by reduced-dose radiotherapy for biopsy-proven CNS germinoma with elevated beta-human chorionic gonadotropin.
In this study, 10 patients with biopsy-proven germinoma with a beta-human chorionic gonadotropin (β-HCG) level >50 mIU/ml received intensive chemotherapy followed by reduced-dose radiotherapy (RT) to reduce late effects from RT. CSF β-HCG levels were >200 mIU/ml in five patients. After endoscopic or stereotactic biopsy, four cycles of induction chemotherapy were administered prior to RT. A CEB regimen (carboplatin + etoposide + bleomycin) and a CyEB regimen (cyclophosphamide + etoposide + bleomycin) were alternated. No residual tumor remained after induction chemotherapy in six patients, only cystic lesions were present at the primary tumor site in three, and a small solid residual tumor was observed in the remaining patient; however, all these patients had normal β-HCG levels. If complete response was achieved before initiation of RT, 19.5 Gy craniospinal RT (CSRT) + 10.8 Gy local RT was administered to the tumor bed. If residual lesion was suspected, the dose of RT was selected according to the presence/absence of tumor dissemination at diagnosis (19.5 Gy CSRT + 19.8 Gy local RT for localized tumors and 24.0 Gy CSRT + 16.2 Gy local RT for disseminated tumors). Eight patients, including four patients with a β-HCG level >200 mIU/ml, received 19.5 Gy CSRT. All patients remain disease free at a median follow-up of 58 (range 35-94) months from diagnosis. Our data suggest that pathologically pure germinoma with a significantly elevated β-HCG level might be cured with reduced-dose RT if intensive chemotherapy is provided.
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Do Hoon
DH
Lim
Keon Hee
KH
Yoo
Na Hee
NH
Lee
Soo Hyun
SH
Lee
Ki Woong
KW
Sung
Hong Hoe
HH
Koo
Ji Hye
JH
Kim
Yeon-Lim
YL
Suh
Yoo Sook
YS
Joung
Hyung Jin
HJ
Shin
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D001932:Brain Neoplasms / Q000628:therapy; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D059248:Chemoradiotherapy / Q000379:methods*; D002648:Child; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000134:cerebrospinal fluid; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D018237:Germinoma / Q000378:metabolism / Q000628:therapy*; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods*; D008297:Male; D011879:Radiotherapy Dosage; D055815:Young Adult
D018997:Chorionic Gonadotropin, beta Subunit, Human; D001761:Bleomycin; D005047:Etoposide; D003520:Cyclophosphamide; D016190:Carboplatin