Long-Term Outcomes and Sequelae Analysis of Intracranial Germinoma: Need to Reduce the Extended-Field Radiotherapy Volume and Dose to Minimize Late Sequelae
- Author:
Joo Ho LEE
1
;
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
Author Information
- Publication Type:Original Article
- From:Cancer Research and Treatment 2021;53(4):983-990
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:We aimed to refine the radiotherapy (RT) volume and dose for intracranial germinoma considering recurrences and long-term toxicities.
Materials and Methods:Total 189 patients with intracranial germinoma were treated with RT alone (n=50) and RT with upfront chemotherapy (CRT) (n=139). All cases were confirmed histologically. RT fields comprised the extended-field and involved-field only for primary site. The extended-field, including craniospinal, whole brain (WB), and whole ventricle (WV) for cranial field, is followed by involved-field boost. The median follow-up duration was 115 months.
Results:The relapses developed in 13 patients (6.9%). For the extended-field, cranial RT dose down to 18 Gy exhibited no cranial recurrence in 34 patients. In CRT, 74 patients (56.5%) showed complete response to chemotherapy and no involved-field recurrence with low-dose RT of 30 Gy. WV RT with chemotherapy for the basal ganglia or thalamus germinoma showed no recurrence. Secondary malignancy developed in 10 patients (5.3%) with a latency of 20 years (range, 4 to 26 years) and caused mortalities in six. WB or craniospinal field rather than WV or involved-field significantly increased the rate of hormone deficiencies, and secondary malignancy. RT dose for extended-field correlated significantly with the rate of hormone deficiencies, secondary malignancy, and neurocognitive dysfunction.
Conclusion:De-intensifying extended-field rather than involved-field or total scheme of RT will be critical to decrease the late toxicities. Upfront chemotherapy could be beneficial for the patients with complete response to minimize the RT dose down to 30 Gy. Prospective trials focused on de-intensification of the extended-field RT are warranted.
