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Children whose non-germinomatous germ cell tumour of the brain responded to chemotherapy did well with radiotherapy limited to the ventricles rather than the whole brain and spine, but the few who relapsed all relapsed in the spine, so the smaller field carries a specific risk.
Children's Oncology Group phase 2 trial: 107 patients aged 3 to 21 with localised non-germinomatous germ cell tumours received six cycles of carboplatin, etoposide and ifosfamide; the 66 with a complete or partial response received 30.6 Gy whole-ventricular irradiation with a boost to 54 Gy instead of craniospinal irradiation.
Three-year progression-free survival was 87.8 percent and overall survival 92.4 percent, compared with 92 and 94.1 percent in ACNS0122 with full-dose craniospinal irradiation. Ten recurrences prompted early closure; on central review eight of 66 reduced-radiotherapy patients progressed, six with isolated spinal relapse and two with combined local and spinal relapse.
Whole-ventricular irradiation with a boost is a reasonable option after a good response to chemotherapy, but the spinal failure pattern shaped the next trial and keeps craniospinal irradiation as an alternative.
Shares Germ cell tumours of childhood and adolescence (extracranial and CNS), Journal of Clinical Oncology.
Shares Central nervous system germ cell tumours (germinoma and non-germinomatous), Germ cell tumours of childhood and adolescence (extracranial and CNS).
Shares Central nervous system germ cell tumours (germinoma and non-germinomatous), Germ cell tumours of childhood and adolescence (extracranial and CNS).
Shares ACNS0122, Central nervous system germ cell tumours (germinoma and non-germinomatous).
Shares ACNS0122, ACNS1123, Central nervous system germ cell tumours (germinoma and non-germinomatous), Germ cell tumours of childhood and adolescence (extracranial and CNS).
Shares Central nervous system germ cell tumours (germinoma and non-germinomatous), Germ cell tumours of childhood and adolescence (extracranial and CNS).