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This large European trial showed that localised intracranial germinoma can be cured in almost every patient either with craniospinal radiotherapy or with chemotherapy followed by smaller-field radiotherapy, but that the reduced field must cover the ventricles to avoid relapse.
Prospective non-randomised trial of 235 patients with intracranial germinoma treated by choice with craniospinal irradiation (24 Gy plus boost) or two cycles of carboplatin, etoposide and ifosfamide followed by focal radiotherapy (40 Gy); metastatic disease received craniospinal irradiation.
Five-year event-free survival was 97 percent with craniospinal irradiation and 88 percent with the combined approach; relapses after focal radiotherapy occurred mainly in the ventricles, prompting whole-ventricular irradiation in the successor trial.
Chemotherapy followed by whole-ventricular irradiation with a tumour boost, rather than craniospinal irradiation, is the standard for localised germinoma, sparing children the neurocognitive and endocrine cost of wider fields.
Shares Neuro-Oncology, Central nervous system germ cell tumours (germinoma and non-germinomatous).
Shares Neuro-Oncology, Central nervous system germ cell tumours (germinoma and non-germinomatous).