Table 3. Selected recent studies examining reduced-volume RT used in conjunction with chemotherapy for M0 intracranial NGGCT.
| Lead author (Year) [Ref number] | # of patientsa | Treatment(s) | Relevant outcome measures | Conclusions regarding reduced-field RT |
|---|---|---|---|---|
| Matsutani (1997)[5] | 19 | Chemo→RT→Chemo Pre- and post-RT chemo: Cisplatin/VP-16 or carboplatin/VP-16 RT: 50-60 Gy |
Mdn f/u: 8.1 yrs (entire cohort) FFS at 2 yrs: 56% 24% of failures outside of primary site |
Histologies conferring a poor prognosis (e.g. choriocarcinoma, yolk sac tumor, embryonal carcinoma) may benefit from more aggressive therapy |
| Robertson (1997)[18] | 11 | Surgery→Chemo→RT→Chemo Pre-RT chemo: VP-16+cisplatin x 3-4 Local RT: mdn 50.4 Gy (range, 20-55 Gy) Post-RT chemo: Vinblastine +bleomycin + VP-16 + carboplatin x 4 |
Mdn f/u: 2.7 yrs Relapses: 3 distant (at 1.1, 2.5, 7.3 yrs) 2 local (at 0.1, 2 yrs) 4-yr OS: 74%, 4-yr FFS: 67% |
The observed spinal relapses suggest a potential role for CSI in patients not achieving CR to chemotherapy |
| Buckner (1999)[11] | 7 | Chemo±surgery→RT Chemo: VP-16 + cisplatin x 4 Local RT: mdn 54 Gy (range, 30.6-59.4 Gy) |
Mdn f/u: 3.5 yrs Relapses: None |
Chemotherapy followed by reduced-dose tumor-only RT is safe and associated with low morbidity |
| Patte (2002)[20]b | 33 | Chemo±surgery→RT Chemo: Carboplatin / VP-16 + VP-16 / ifosfamide x 3-4 Local RT: 50-55 Gy |
Mdn f/u: 5.1 yrs Relapses: Exact # unknown (“mainly spinal” at mdn 11 months) EFS: 67±14%, OS: 77±8% |
The observed spinal relapses reflect the possibility that CSI may be needed in higher-risk patients |
| Calaminus (2012)[16]b | 146 | Chemo→RT Chemo: Cisplatin + VP-16 + ifosfamide Local RT: 54 Gy |
Mdn f/u: 4.4 yrs Relapses: 23 local, 5 distant, 8 combined FFS at 4.4 yrs=69±4%, OS at 3.4 yrs=78±4% 12/22 patients with AFP > 1000 ng/mL relapsed |
Local RT is sufficient for local disease control but CSI may be needed to control microscopic disease |
| Robertson (2014)[21] | 16 | Chemo±surgery±chemo→RT Chemo: Cisplatin + VP-16 + ifosfamide x 4 Post-surgery chemo: Carboplatin + cyclophosphamide x 2 RT: WVI to 36 Gy + tumor boost (54 Gy) |
Mdn f/u 7.1 yrs Relapses: 1 local, 3 spine, 1leptomeninges, 1 combined |
CR before RT was not a prognostic factor; given the high rate of relapse in WVI patients, CSI should be recommended even to patients achieving CR to chemotherapy |
| Current study (2017) | 16 | Chemo±surgery→RT Chemo: COG protocols, as described RT: WVI to mdn 30.6 Gy (range, 30.6-36 Gy) + tumor-boost (54 Gy) or tumor-only to mdn 54 Gy (range 50.4-54 Gy) |
Mdn f/u: 4.1 yrs Relapses: 3 local (at 0.8, 0.8, and 0.9 yrs), with 1 also relapsing in leptomeninges (2.5 yrs) 4-yr OS: 92%, 4-yr FFS: 81% |
Reduced-volume RT may be feasible in low-risk subgroups, but further data and longer-term follow-up are needed |
a
Only includes NGGCT patients receiving chemotherapy and reduced-volume RT.
b
Data is available in abstract-form only.
CR=complete response, CSI=craniospinal irradiation, Gy = gray, f/u = follow-up, FFS=failure-free survival, EFS=event-free survival, IC=intracranial, NGGCT=non-germinoma germ cell tumor, M0 = non-metastatic, mdn=median, OS=overall survival, PR=partial response, VP-16 = etoposide, WVI = whole ventricular irradiation, yrs=years.