Long-term follow-up of intensive chemotherapy followed by reduced-dose and reduced-field irradiation for intracranial germ cell tumor

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In Brief

In this study of patients with intracranial germ cell tumors, intensive chemotherapy followed by reduced-dose and reduced-field irradiation had the same outcome as that reported in the literature, but late adverse effects after treatment were observed. Although almost all of the complications were relatively mild, they had the potential to lead to psychiatric disorders and intracranial hemorrhaging. The data of long-term follow-up beyond 10 years will prove valuable.

ABBREVIATIONS AFP = alpha-fetoprotein; CDC = conventional-dose chemotherapy; CMB = cerebral microbleed; CRT = chemoradiotherapy; CSI = craniospinal irradiation; EP = etoposide and cisplatin; GCT = germ cell tumor; HCG = human chorionic gonadotropin; HDC = high-dose chemotherapy; ICE = ifosfamide, cisplatin, and etoposide; NGGCT = nongerminomatous GCT; OS = overall survival; PBSCT = peripheral blood stem cell transplantation; PFS = progression-free survival; RICM = radiation-induced cavernous malformation; STGC = syncytiotrophoblastic giant cell; SWI = susceptibility-weighted imaging.

Article Information

Correspondence Akinori Takada: Mie University Hospital, Tsu City, Mie, Japan. a-takada@clin.medic.mie-u.ac.jp.

INCLUDE WHEN CITING Published online November 23, 2018; DOI: 10.3171/2018.9.PEDS18181.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Kaplan-Meier survival curves of the OS (left) and PFS (right) rates for all 24 patients. Dashed lines represent 95% confidence intervals.

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    Kaplan-Meier survival curves of the OS rates according to the histological subtype (left) and primary lesion (right).

References

1

Acharya SDeWees TShinohara ETPerkins SM: Long-term outcomes and late effects for childhood and young adulthood intracranial germinomas. Neuro Oncol 17:7417462015

2

Al-Holou WNO’Lynnger TMPandey ASGemmete JJThompson BGMuraszko KM: Natural history and imaging prevalence of cavernous malformations in children and young adults. J Neurosurg Pediatr 9:1982052012

3

Aoyama HShirato HIkeda JFujieda KMiyasaka KSawamura Y: Induction chemotherapy followed by low-dose involved-field radiotherapy for intracranial germ cell tumors. J Clin Oncol 20:8578652002

4

Armstrong GTLiu QYasui YHuang SNess KKLeisenring W: Long-term outcomes among adult survivors of childhood central nervous system malignancies in the Childhood Cancer Survivor Study. J Natl Cancer Inst 101:9469582009

5

Brinkman TMBass JKLi ZNess KKGajjar APappo AS: Treatment-induced hearing loss and adult social outcomes in survivors of childhood CNS and non-CNS solid tumors: Results from the St. Jude Lifetime Cohort Study. Cancer 121:405340612015

6

Brinkman TMLi CVannatta KMarchak JGLai JSPrasad PK: Behavioral, social, and emotional symptom comorbidities and profiles in adolescent survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Clin Oncol 34:341734252016

7

Cutsforth-Gregory JKLanzino GLink MJBrown RD JrFlemming KD: Characterization of radiation-induced cavernous malformations and comparison with a nonradiation cavernous malformation cohort. J Neurosurg 122:121412222015

8

Echevarría MEFangusaro JGoldman S: Pediatric central nervous system germ cell tumors: a review. Oncologist 13:6906992008

9

Goldman SBouffet EFisher PGAllen JCRobertson PLChuba PJ: Phase II trial assessing the ability of neoadjuvant chemotherapy with or without second-look surgery to eliminate measurable disease for nongerminomatous germ cell tumors: A Children’s Oncology Group Study. J Clin Oncol 33:246424712015

10

Gross BADu ROrbach DBScott RMSmith ER: The natural history of cerebral cavernous malformations in children. J Neurosurg Pediatr 17:1231282016

11

Matsutani M: Combined chemotherapy and radiation therapy for CNS germ cell tumors—the Japanese experience. J Neurooncol 54:3113162001

12

Haas-Kogan DAMissett BTWara WMDonaldson SSLamborn KRPrados MD: Radiation therapy for intracranial germ cell tumors. Int J Radiat Oncol Biol Phys 56:5115182003

13

Horowitz MBHall WA: Central nervous system germinomas. A review. Arch Neurol 48:6526571991

14

Jennings MTGelman RHochberg F: Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg 63:1551671985

15

Jensen AWLaack NNBuckner JCSchomberg PJWetmore CJBrown PD: Long-term follow-up of dose-adapted and reduced-field radiotherapy with or without chemotherapy for central nervous system germinoma. Int J Radiat Oncol Biol Phys 77:144914562010

16

Kellie SJBoyce HDunkel IJDiez BRosenblum MBrualdi L: Primary chemotherapy for intracranial nongerminomatous germ cell tumors: results of the second international CNS germ cell study group protocol. J Clin Oncol 22:8468532004

17

Kiltie AEGattamaneni HR: Survival and quality of life of paediatric intracranial germ cell tumour patients treated at the Christie Hospital, 1972-1993. Med Pediatr Oncol 25:4504561995

18

Liang SYYang TFChen YWLiang MLChen HHChang KP: Neuropsychological functions and quality of life in survived patients with intracranial germ cell tumors after treatment. Neuro Oncol 15:154315512013

19

Loren AWMangu PBBeck LNBrennan LMagdalinski AJPartridge AH: Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 31:250025102013

20

Matsutani MSano KTakakura KFujimaki TNakamura OFunata N: Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg 86:4464551997

21

Matsutani MTakakura KSano K: Primary intracranial germ cell tumors: pathology and treatment. Prog Exp Tumor Res 30:3073121987

22

O’Neil SJi LBuranahirun CAzoff JDhall GKhatua S: Neurocognitive outcomes in pediatric and adolescent patients with central nervous system germinoma treated with a strategy of chemotherapy followed by reduced-dose and volume irradiation. Pediatr Blood Cancer 57:6696732011

23

Packer RJGurney JGPunyko JADonaldson SSInskip PDStovall M: Long-term neurologic and neurosensory sequelae in adult survivors of a childhood brain tumor: childhood cancer survivor study. J Clin Oncol 21:325532612003

24

Passos JNzwalo HMarques JAzevedo ANetto ENunes S: Late cerebrovascular complications after radiotherapy for childhood primary central nervous system tumors. Pediatr Neurol 53:2112152015

25

Peters SPahl RClaviez AJansen O: Detection of irreversible changes in susceptibility-weighted images after whole-brain irradiation of children. Neuroradiology 55:8538592013

26

Poynter JNFonstad RTolar JSpector LGRoss JA: Incidence of intracranial germ cell tumors by race in the United States, 1992-2010. J Neurooncol 120:3813882014

27

Roddy ESear KFelton ETamrazi BGauvain KTorkildson J: Presence of cerebral microbleeds is associated with worse executive function in pediatric brain tumor survivors. Neuro Oncol 18:154815582016

28

Rosenblum MKNakazato YMatsutani M: CNS germ cell tumors in: WHO Classification of Tumours of the Central Nervous Systemed 3. Albany, NY: WHO Publication Center2007 p 197

29

Sawamura Yde Tribolet NIshii NAbe H: Management of primary intracranial germinomas: diagnostic surgery or radical resection? J Neurosurg 87:2622661997

30

Sawamura YIkeda JShirato HTada MAbe H: Germ cell tumours of the central nervous system: treatment consideration based on 111 cases and their long-term clinical outcomes. Eur J Cancer 34:1041101998

31

Sawamura YShirato HIkeda JTada MIshii NKato T: Induction chemotherapy followed by reduced-volume radiation therapy for newly diagnosed central nervous system germinoma. J Neurosurg 88:66721998

32

Souweidane MMKrieger MDWeiner HLFinlay JL: Surgical management of primary central nervous system germ cell tumors: proceedings from the Second International Symposium on Central Nervous System Germ Cell Tumors. J Neurosurg Pediatr 6:1251302010

33

Yeom KWLober RMPartap STelischak NTsolinas RBarnes PD: Increased focal hemosiderin deposition in pediatric medulloblastoma patients receiving radiotherapy at a later age. J Neurosurg Pediatr 12:4444512013

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