Successful treatment of intracranial nongerminomatous malignant germ cell tumors by administering neoadjuvant chemotherapy and radiotherapy before excision of residual tumors

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Object. The goal of this study was to confirm the effectiveness of our novel treatment strategy, neoadjuvant therapy (NAT) consisting of combined chemo- and radiotherapy, which are performed before complete excision of residual tumor in patients with intracranial nongerminomatous malignant germ cell tumors (NGMGCTs).

Methods. The authors treated 11 consecutive patients with NGMGCTs by applying NAT consisting of combined platinum-based chemotherapy and radiotherapy, followed by complete excision of residual tumors. The pretreatment diagnosis, based on tumor markers with or without biopsy, was yolk sac tumor in five patients, embryonal carcinoma in one patient, immature teratoma in one patient, and mixed germ cell tumor containing malignant tumor components in four patients.

Among the 11 patients, NAT achieved a complete response in two and a partial response in six patients; two patients manifested no change and one suffered disease progression. Residual tumors that occurred post-NAT were surgically removed in nine patients. Of the 11 patients, 10 are currently alive without recurrence of their disease, 30 to 177 months (mean 96 months) after diagnosis. In one patient a leptomeningeal tumor recurred and he died of the disease 21 months after diagnosis.

Conclusions. Neoadjuvant therapy, consisting of combined chemo- and radiotherapy, followed by complete excision of residual tumors is highly effective in patients with intracranial NGMGCTs.

Article Information

Address reprint requests to: Masato Kochi, M.D., Ph.D., Department of Neurosurgery, Kumamoto University Medical School, 1–1–1 Honjo, Kumamoto 860–8556, Japan. email: kochim@kaiju.medic.kumamoto-u.ac.jp.

© AANS, except where prohibited by US copyright law.

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Figures

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    Kaplan—Meier graph demonstrating overall survival in patients with intracranial NGMGCTs treated with neoadjuvant therapy followed by complete excision of residual tumors.

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    Case 9. Magnetic resonance images obtained in an 11-year-old boy. Left: Gadolinium-enhanced image obtained before treatment. Center: Image revealing a residual tumor after three courses of chemotherapy and concomitant radiotherapy. The residual tumor was totally removed by surgery. Right: Postoperative image obtained 3 years and 3 months postdiagnosis.

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    Case 10. Magnetic resonance images obtained in a 28-year-old woman. Left: Gadolinium-enhanced image obtained before treatment. Center: Image demonstrating a residual tumor after three courses of chemotherapy and concomitant radiotherapy. The residual tumor was totally removed by surgery. Right: Postoperative image obtained 3 years and 3 months postdiagnosis.

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    Case 11. Magnetic resonance images obtained in a 12-year-old boy. Upper Left: Gadolinium-enhanced image obtained 2 weeks after the start of treatment. Upper Right: Image acquired after three courses of chemotherapy and concomitant radiotherapy. Lower Left: The residual tumor regrew within 1 month and it was totally removed by surgery. Lower Right: Postoperative image obtained 2 years and 6 months postdiagnosis.

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    Case 11. Photomicrographs. Left: The resected tumor displaying nuclear pleomorphism, numerous mitoses, gland formation, and eosinophilic hyaline globules. Right: An additional slice of tumor. H & E (left) and immunostaining for AFP (right); original magnifications × 200.

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