Radiation therapy for relapsed CNS germinoma after primary chemotherapy Journal Article
| Authors: | Merchant, T. E.; Davis, B. J.; Sheldon, J. M.; Leibel, S. A. |
| Article Title: | Radiation therapy for relapsed CNS germinoma after primary chemotherapy |
| Abstract: | Purpose: To retrospectively evaluate the ability of radiation therapy to salvage patients with CNS germinoma who relapsed after treatment with primary chemotherapy on a multiinstitution trial that included carboplatin, etoposide, and bleomycin (PEB). Patients and Methods: Eight patients with CNS germinoma received carboplatin, etoposide, and bleomycin as their only nonsurgical treatment following their initial diagnosis. At the time of relapse each patient received high-dose cyclophosphamide (one to three cycles) followed by craniospinal irradiation (25.2 to 36 Gy) and a boast to the site of recurrent disease (45 to 54 Gy). Six of eight patients had disease at relapse that was more extensive than at diagnosis. One patient had magnetic resonance imaging (MRI) evidence of leptomeningeal enhancement in the cauda equina although CSF cytology was negative, and one patient had cytologic evidence of CSF involvement. The median time to relapse following primary chemotherapy was 17 months. Results: Although myelosuppression was prolonged following the administration of preirradiation chemotherapy, all patients completed a continuous course of radiation therapy. With a median follow-up after radiation therapy of 32 months (range, 16 to 47 months), no failures have occurred. Conclusion: Radiation therapy has a proven record of efficacy in the treatment of intracranial germinoma and it remains the standard therapy with which others are compared for treatment response, local control, and overall survival. Arguments can be made for alternative approaches when patients face hormonal or neurocognitive dysfunction as a result of radiation therapy; however, any reduction in late effects will have to be weighed against the probability of survival if alternative approaches prove to be inferior. |
| Keywords: | adolescent; adult; cancer survival; child; clinical article; child, preschool; disease-free survival; retrospective studies; cancer recurrence; multimodality cancer therapy; nuclear magnetic resonance imaging; brain neoplasms; carboplatin; neoplasm recurrence, local; bone marrow suppression; etoposide; antineoplastic combined chemotherapy protocols; cyclophosphamide; central nervous system tumor; cranial irradiation; irradiation; bleomycin; cancer control; germ cell tumor; neurologic disease; endocrine disease; cauda equina; germinoma; meninx; humans; human; male; female; priority journal; article |
| Journal Title: | Journal of Clinical Oncology |
| Volume: | 16 |
| Issue: | 1 |
| ISSN: | 0732-183X |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 1998-01-01 |
| Start Page: | 204 |
| End Page: | 209 |
| Language: | English |
| PUBMED: | 9440744 |
| PROVIDER: | scopus |
| DOI: | 10.1200/jco.1998.16.1.204 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 12 December 2016 -- Source: Scopus |
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