Treatment results and prognostic factors for intracranial nongerminomatous germ cell tumors: single institute experience.
OBJECTIVE
This study aimed to evaluate the treatment of intracranial nongerminomatous germ cell tumors (NGGCT) and to identify the prognostic factors for survival.


METHODS
Thirty-nine patients with nondisseminated NGGCTs, excluding those with pure mature teratomas, were treated between January 1985 and December 2010. Twenty-four patients received gross total or partial removal, 11 had excision biopsies, and 4 had no surgery. Radiotherapy was given postoperatively or definitively with a median tumor bed dose of 54 Gy (range 30-54) with or without craniospinal irradiation. All patients received ten cycles of adjuvant chemotherapy, vinblastine, bleomycin, etoposide, and cisplatin after radiotherapy, except for one with mixed anaplastic astrocytoma component who received oral temozolomide. Survival and prognostic factors were estimated by the Kaplan-Meier method and log-rank tests, respectively.


RESULTS
After a median follow-up of 77.7 months (range 14-336), the 6-year overall survival (OS) and progression-free survival (PFS) were 74.4 and 79.5 %, respectively. Inferior PFS was associated with lesions in the suprasellar region (p = 0.017), poor pathological features (p = 0.048), and with poor image (p < 0.0001) and tumor marker (TM) response (p = 0.003) to irradiation. Decreased OS was associated with lesions in the suprasellar region (p = 0.026) and with poor image (p < 0.0001) and TM response (p = 0.027) to irradiation. Neither the extent of surgery nor the radiation field was found to significantly influence survival.


CONCLUSIONS
By our multimodality approach, patients achieved comparable outcomes. Other than poor pathological features, patients with poor responses to radiotherapy are prone to early recurrence and inferior survival. These patients should be focused for more intensive adjuvant treatment.
Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, No. 201, Sec.2, Shi-Pai Road, Taipei, 11217, Taiwan.
I-Chun
IC
Lai
Tai-Tong
TT
Wong
Cheng-Ying
CY
Shiau
Yu-Wen
YW
Hu
Donald Ming-Tak
DM
Ho
Kai-Ping
KP
Chang
Wan-Yuo
WY
Guo
Feng-Chi
FC
Chang
Muh-Lii
ML
Liang
Yi-Yen
YY
Lee
Hsin-Hung
HH
Chen
Sang-Hue
SH
Yen
Yi-Wei
YW
Chen
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D061888:Craniospinal Irradiation; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D018572:Disease-Free Survival; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D019635:Neurosurgical Procedures / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D000077204:Temozolomide; D016896:Treatment Outcome; D014747:Vinblastine / Q000627:therapeutic use; D055815:Young Adult
D001761:Bleomycin; D014747:Vinblastine; D005047:Etoposide; D003606:Dacarbazine; D002945:Cisplatin; D000077204:Temozolomide