Improvement of Long-term Results with Neoadjuvant Chemotherapy and Radiotherapy for Central Nervous System Germinoma.

Abstract

To evaluate the role of neoadjuvant chemotherapy and radiotherapy in the treatment of central nervous system germinomas in 38 patients who received definitive treatment and were followed-up >5 years between 1980 and 2009. The median age at diagnosis and follow-up period were 16.5 years and 128.3 months, respectively. Treatment was irradiation alone or adjuvant platinum-based chemotherapy followed by reduced-dose local irradiation. Seven patients progressed at 12.9-133.9 months and 1 died of disease 89.3 months after therapy initiation. The treatment strategies were divided into 3 groups: group A (1980-1988, n = 5), whole brain with local irradiation; group B (1989-2002, n = 16), chemotherapy with or without reduced irradiation dose; and group C (2003-2009, n = 17): neoadjuvant chemotherapy (3 courses) followed by 30.6 Gy of whole ventricle irradiation for patients with localized complete response, and additional local boost of 19.8 Gy for others. There were 7 recurrent cases, all in group B. The progression-free survival was significantly longer in groups A and C versus group B (P < 0.001). Decreased Karnofsky performance status was observed in 2 (40%), 6 (37.5%), and 0 cases in groups A-C, respectively. The main reasons for the good results in group C might be the neoadjuvant chemotherapy with whole ventricle radiotherapy and introduction of neuroendoscopy, especially for pineal lesions, resulting in a substantial reduction of time from the diagnosis to first treatment. Chemotherapy followed by whole ventricle radiotherapy, with or without local boost, and with use of neuroendoscopy results in good disease control without late complications in patients with germinomas.