Table 2.
Treatment characteristics and outcomes for 20 patients with central nervous system germ cell tumors.
| Presentation |
Surgery | Chemotherapy |
Radiation therapy |
Outcomes |
||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pt # | Sex | Age (yrs) | Tumor |
Initial resection | Type (cycles) | Response | Initial volume | Dose [Gy(RBE)] |
Response (3 mo f/u) | Progression (Salvage) | At last follow-up | |||
| Type | Location | Initial | Boost | Total | ||||||||||
| 1 | F | 11 | Germinoma | Suprasellar | Biopsy | — | — | WVRT−4th | 25.2 | 16.2 | 41.4 | CR | No | NED |
| 2 | M | 13 | Germinoma | Pineal | Biopsy⁎ | — | — | WVRT−4th | 25.2 | 19.8 | 45.0 | CR | No | NED |
| 3 | M | 16 | Germinoma | Pineal | Biopsy⁎ | CE(2) + PC(2) | PR | WVRT−4th | 21.6 | 18.0 | 39.6 | CR | No | NED |
| 4 | M | 12 | Germinoma | DD | Biopsy | CE(2) + PC(2) | PR | CSI | 21.0 | 9.0 | 30.0 | CR | No | NED |
| 5 | F | 8 | Germinoma | DD | STR | CE(1)⁎⁎ | PR | CSI | 21.6 | 18.0 | 39.6 | CR | No | NED |
| 6 | M | 15 | Germinoma | Bifocal | Biopsy | — | — | CSI | 21.6 | 23.4 | 45.0 | CR | No | NED |
| 7 | F | 16 | Germinoma | DD | Biopsy | CE(2) | CR | CSI | 21.6 | 23.4 | 45.0 | NED | No | NED |
| 8 | F | 8 | Germinoma | Suprasellar | Biopsy⁎ | ICE(6) | PR | WVRT−4th | 23.4 | 21.6 | 45.0 | CR | Yes (IMRT) | NED |
| 9 | M | 9 | Germinoma | Pineal | Biopsy | — | — | WVRT† | 23.4 | 21.6 | 45.0 | CR | No | NED |
| 10 | M | 12 | NGGCT | Pineal | Biopsy⁎ | ICE (6) | SD | CSI | 36.0 | 18.0 | 54.0 | PR | Yes (chemo) | Alive w/disease |
| 11 | M | 12 | NGGCT | Pineal | Shunt | ICE (6) | SD | CSI | 30.6 | 23.4 | 54.0 | SD | No‡ | NED |
| 12 | F | 13 | NGGCT | Suprasellar | Shunt⁎ | ICE (6) | CR | CSI | 30.6 | 23.4 | 54.0 | NED | No | NED |
| 13 | M | 14 | NGGCT | DD | Biopsy | ICE (6) | PR | CSI | 36.0 | 18.0 | 54.0 | CR | No | NED |
| 14 | M | 14 | NGGCT | Pineal | Shunt | ICE (6) | PD | CSI | 30.6 | 23.4 | 54.0 | SD | No | NED |
| 15 | M | 12 | NGGCT | Pineal | Biopsy⁎ | ICE (3)⁎⁎ | SD | CSI | 36.0 | 18.0 | 54.0 | SD | Yes§ | Deceased |
| 16 | F | 14 | NGGCT | DD | — | ICE (6) | PR | CSI | 30.6 | 23.4 | 54.0 | CR | No | NED |
| 17 | F | 4 | NGGCT | Suprasellar | STR | PEI (4)⁎⁎⁎ | CR | WVRT | 21.6 | 32.4 | 54.0 | NED | No | NED |
| 18 | F | 5 | NGGCT | Suprasellar | STR/GTR⁎ | ICE (6) | NED | CSI | 36.0 | 14.4 | 50.4 | NED | No | NED |
| 19 | M | 13 | NGGCT | Pineal | — | ICE (6) | CR | CSI | 30.6 | 23.4 | 54.0 | NED | Yes (none) | Deceased |
| 20 | F | 9 | NGGCT | DD | — | ICE (6) | PR | CSI | 36.0 | 18.0 | 54.0 | CR | No | NED |
Abbreviations: NGGCT, nongerminomatous germ cell tumor; DD, disseminated disease; STR, subtotal resection; GTR, gross total resection; CE, carboplatin, etoposide; PC, cisplatin, cyclophosphamide; ICE, ifosfamide, carboplatin, etoposide; PEI, cisplatin, etoposide, ifosfamide; PD, progressive disease; SD, stable disease; PR, partial response; CR, complete response; NED, no evidence of active disease; WVRT−4th, whole-ventricular radiotherapy (excluding the fourth ventricle); CSI, craniospinal irradiation; IMRT, intensity-modulated (photon) radiation therapy.
Additional surgical interventions before radiation therapy included shunt placement, additional biopsy, or both.
Chemotherapy-related toxicity prevented completion of additional planned cycles.
Last two of four cycles consisted of high-dose PEI followed by autologous stem cell rescue.
Patient received intensity-modulated proton therapy (IMPT); all others received 3D-conformal proton therapy.
Cyst growth requiring shunt placement for symptomatic hydrocephalus at 5.5 years follow-up; no change in solid tumor and tumor markers remained normal throughout follow-up.
Refractory to chemoradiotherapy; salvaged with gross total resection, high dose chemotherapy (temozolomide, thiotepa, carboplatin), and autologous stem cell rescue followed by 13 cis-retinoic acid.