Chemotherapy without irradiation - A novel approach for newly diagnosed CNS germ cell tumors: Results of an international cooperative trial Journal Article

Authors: Balmaceda, C.; Heller, G.; Rosenblum, M.; Diez, B.; Villablanca, J. G.; Kellie, S.; Maher, P.; Vlamis, V.; Walker, R. W.; Leibel, S.; Finlay, J. L.; for the First International Central Nervous System Germ Cell Tumor Study
Contributor: Thompson, S.
Article Title: Chemotherapy without irradiation - A novel approach for newly diagnosed CNS germ cell tumors: Results of an international cooperative trial
Abstract: Purpose: Radiation therapy for CNS germ cell tumors (GCT) is commonly associated with neurologic sequelae. We designed a therapeutic trial to determine whether irradiation could be avoided. Patients and Methods: Patients received four cycles of carboplatin, etoposide, and bleomycin. Those with a complete response (CR) received two further cycles; others received two cycles intensified by cyclophosphamide. Results: Seventy-one patients were enrolled (45 with germinoma and 26 with nongerminomatous GCT [NGGCT]). Sixty-eight were assessable for response. Thirty-nine of 68 (57%) achieved a CR within four cycles. Of 29 patients with less than a CR, 16 achieved CR with intensified chemotherapy or second surgery. Overall, 55 of 71 (78%) achieved a CR without irradiation. The CR rate was 84% for germinomas and 78% for NGGCT. With a median follow-up duration of 31 months, 28 of 71 patients were alive without relapse or progression. Thirty-five showed tumor recurrence (n = 28) or progression (n = 7) at a median of 13 months. Twenty- six of 28 patients (93%) who recurred following remission underwent successful salvage therapy. Pathology was the only variable predictive of survival. The probability of surviving 2 years was .84 for germinoma patients and .62 for NGGCT. Seven of 71 patients died of toxicity associated with study chemotherapy. Conclusion: Forty-one percent of surviving patients an 50% of all patients were treated successfully with chemotherapy only without irradiation. Chemotherapy only regimens for CNS GCT, although encouraging, should continue to be used only in the setting of formal clinical trials.
Keywords: adolescent; adult; cancer chemotherapy; cancer survival; child; controlled study; treatment outcome; child, preschool; survival rate; major clinical study; clinical trial; cancer recurrence; gadolinium; nuclear magnetic resonance imaging; carboplatin; controlled clinical trial; etoposide; blood toxicity; antineoplastic combined chemotherapy protocols; cyclophosphamide; hemoglobin; tumor marker; central nervous system tumor; central nervous system neoplasms; infant; irradiation; bleomycin; germ cell tumor; intravenous drug administration; chorionic gonadotropin beta subunit; alpha fetoprotein; cerebrospinal fluid cytology; germinoma; myelography; humans; human; male; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 14
Issue: 11
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 1996-11-01
Start Page: 2908
End Page: 2915
Language: English
PUBMED: 8918487
PROVIDER: scopus
DOI: 10.1200/JCO.1996.14.11.2908
Notes: Article -- Export Date: 22 November 2017 -- Source: Scopus
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MSK Authors
  1. Glenn Heller
    303 Heller
  2. Marc Rosenblum
    255 Rosenblum
  3. Steven A Leibel
    220 Leibel
  4. Jonathan Finlay
    62 Finlay
  5. Vaia   Vlamis
    30 Vlamis