Kyung-Nam Koh1, Ru Xin Wong2, Dong-Eun Lee3, Jung Woo Han4, Hwa Kyung Byun5, Hong In Yoon5, Dong-Seok Kim6, Chuhl Joo Lyu4, Hyoung Jin Kang7, Kyung Taek Hong7, Joo Ho Lee8, Il Han Kim8, Ji Hoon Phi9, Seung-Ki Kim9, Tai-Tong Wong10, Hsin-Lun Lee11, I-Chun Lai10, Yu-Mei Kang10, Young-Shin Ra12, Seung Do Ahn13, Ho Joon Im1, Wen Shen Looi2, Sharon Yin Yee Low14,15, Enrica Ee Kar Tan16, Hyun Jin Park17, Sang Hoon Shin18, Hiroshi Fuji19, Chang-Ok Suh20, Yi-Wei Chen21, Joo-Young Kim22. 1. Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea. 2. Department of Radiation Oncology, National Cancer Centre, Singapore, Singapore. 3. Division of Cancer Epidemiology and Management, Research Institute, National Cancer Center, Goyang, Korea. 4. Division of Pediatric Hematology and Oncology, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea. 5. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea. 6. Department of Neurosurgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea. 7. Departments of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea. 8. Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. 9. Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea. 10. Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan. 11. Department of Radiation Oncology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan. 12. Division of Pediatric Neurosurgery, Department of Neurosurgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea. 13. Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 14. Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore. 15. Neurosurgical Service, KK Women's and Children's Hospital, Singapore, Singapore. 16. Department of Pediatric Subspecialties, Pediatric Hematology/Oncology Service, KK Women's and Children's Hospital, Singapore, Singapore. 17. Center for Pediatric Oncology, National Cancer Center, Goyang, Korea. 18. Neuro-Oncology Clinic, National Cancer Center, Goyang, Korea. 19. Department of Radiation Oncology, National Center for Child Health and Development, Tokyo, Japan. 20. Department of Radiation Oncology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea. 21. Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan. 22. Department of Radiation Oncology, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Abstract
BACKGROUND: This multinational study was conducted to report clinical presentations and treatment strategies in patients with intracranial germinomas across selected Asian centers, including failure patterns, risk factors, and outcomes. METHODS: A retrospective data collection and analysis of these patients, treated between 1995 and 2015 from eight healthcare institutions across four countries was undertaken. RESULTS: From the results, 418 patients were analyzed, with a median follow-up of 8.9 years; 79.9% of the patients were M0, and 87.6% had β-human chorionic gonadotropin values <50 mIU/mL. The 5/10-year overall survival (OS) and recurrence-free survival (RFS) rates were 97.2%/96.2% and 89.9%/86.9%, respectively. RFS was predicted by the radiotherapy (RT) field, with focal RT having the worst outcome, whereas chemotherapy usage had no impact on survival. Among patients who received chemotherapy, response to chemotherapy did not predict survival outcomes. In M0 patients, primary basal ganglia tumors predicted a worse RFS. In patients with bifocal tumors, an extended field RT was associated with better outcomes. In multivariable analysis, only RT fields were associated with RFS. In relapsed patients, salvage rates were high at 85.7%. Additionally, patients who received salvage RT had a better outcome (91.6% vs. 66.7%). CONCLUSIONS: Survival outcomes of patients with germinoma were excellent. Thus, the focus of treatment for intracranial germinoma should be on survivorship. Further studies are warranted to find the optimal intensity and volume of radiation, including the role of chemotherapy in the survival of patients with intracranial germinomas, considering age, primary tumor location, and extent of disease.
BACKGROUND: This multinational study was conducted to report clinical presentations and treatment strategies in patients with intracranial germinomas across selected Asian centers, including failure patterns, risk factors, and outcomes. METHODS: A retrospective data collection and analysis of these patients, treated between 1995 and 2015 from eight healthcare institutions across four countries was undertaken. RESULTS: From the results, 418 patients were analyzed, with a median follow-up of 8.9 years; 79.9% of the patients were M0, and 87.6% had β-human chorionic gonadotropin values <50 mIU/mL. The 5/10-year overall survival (OS) and recurrence-free survival (RFS) rates were 97.2%/96.2% and 89.9%/86.9%, respectively. RFS was predicted by the radiotherapy (RT) field, with focal RT having the worst outcome, whereas chemotherapy usage had no impact on survival. Among patients who received chemotherapy, response to chemotherapy did not predict survival outcomes. In M0 patients, primary basal ganglia tumors predicted a worse RFS. In patients with bifocal tumors, an extended field RT was associated with better outcomes. In multivariable analysis, only RT fields were associated with RFS. In relapsed patients, salvage rates were high at 85.7%. Additionally, patients who received salvage RT had a better outcome (91.6% vs. 66.7%). CONCLUSIONS: Survival outcomes of patients with germinoma were excellent. Thus, the focus of treatment for intracranial germinoma should be on survivorship. Further studies are warranted to find the optimal intensity and volume of radiation, including the role of chemotherapy in the survival of patients with intracranial germinomas, considering age, primary tumor location, and extent of disease.
Authors: Dora Correia; Dario Terribilini; Stefan Zepter; Alessia Pica; Nicola Bizzocchi; Werner Volken; Sonja Stieb; Frank Ahlhelm; Evelyn Herrmann; Michael K Fix; Peter Manser; Daniel M Aebersold; Damien C Weber Journal: Clin Transl Radiat Oncol Date: 2019-01-09
Authors: Joo Ho Lee; Keun-Yong Eom; Ji Hoon Phi; Chul-Kee Park; Seung Ki Kim; Byung-Kyu Cho; Tae Min Kim; Dae Seog Heo; Kyung Taek Hong; Jung Yoon Choi; Hyoung Jin Kang; Hee Young Shin; Seung Hong Choi; Soon Tae Lee; Sung Hye Park; Kyu-Chang Wang; Il Han Kim Journal: Cancer Res Treat Date: 2021-01-13 Impact factor: 4.679