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A multimodal approach including craniospinal irradiation improves the treatment outcome of high-risk intracranial nongerminomatous germ cell tumors

Authors
 Jun Won Kim  ;  Woo Chul Kim  ;  Jae Ho Cho  ;  Dong-Seok Kim  ;  Kyu-Won Shim  ;  Chul Joo Lyu  ;  Sung Chul Won  ;  Chang-Ok Suh 
Citation
 INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, Vol.84(3) : 625-631, 2012 
Journal Title
 INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 
ISSN
 0360-3016 
Issue Date
2012
MeSH
Adolescent ; Adult ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Brain Neoplasms/cerebrospinal fluid ; Brain Neoplasms/mortality ; Brain Neoplasms/pathology ; Brain Neoplasms/therapy* ; Cause of Death ; Child ; Child, Preschool ; Choriocarcinoma/cerebrospinal fluid ; Choriocarcinoma/mortality ; Choriocarcinoma/pathology ; Choriocarcinoma/therapy ; Combined Modality Therapy/methods ; Craniospinal Irradiation/methods* ; Disease-Free Survival ; Endodermal Sinus Tumor/cerebrospinal fluid ; Endodermal Sinus Tumor/mortality ; Endodermal Sinus Tumor/pathology ; Endodermal Sinus Tumor/therapy ; Female ; Germinoma/cerebrospinal fluid ; Germinoma/mortality ; Germinoma/pathology ; Germinoma/therapy ; Humans ; Male ; Neoplasm Recurrence, Local/mortality ; Neoplasm Recurrence, Local/pathology ; Neoplasms, Germ Cell and Embryonal/cerebrospinal fluid ; Neoplasms, Germ Cell and Embryonal/mortality ; Neoplasms, Germ Cell and Embryonal/pathology ; Neoplasms, Germ Cell and Embryonal/therapy* ; Radiotherapy Dosage ; Salvage Therapy/methods ; Salvage Therapy/mortality ; Survival Rate ; Teratoma/cerebrospinal fluid ; Teratoma/mortality ; Teratoma/pathology ; Teratoma/therapy ; Young Adult
Keywords
Nongerminomatous germ cell tumor ; Multimodal approach ; Craniospinal irradiation
Abstract
PURPOSE: To evaluate whether a multimodal approach including craniospinal irradiation (CSI) improves treatment outcome in nongerminomatous germ cell tumor (NGGCT) patients. METHODS AND MATERIALS: We reviewed the records of 32 patients with NGGCTs. Fourteen patients belonged to the intermediate prognosis group (immature teratoma, teratoma with malignant transformation, and mixed tumors mainly composed of germinoma or teratoma), and 18 patients belonged to the poor prognosis group (other highly malignant tumors). Patients with pure germinoma or mature teratoma were excluded from this study. Nineteen patients were treated with a combination of surgery, chemotherapy, and radiotherapy (RT); 9 patients received chemotherapy plus RT; 3 patients received surgery plus RT; and 1 patient received RT alone. Twenty-seven patients received CSI with a median of 36 Gy (range, 20-41 Gy) plus focal boost of 18-30.6 Gy, and 5 patients received whole-brain RT (WBRT) (20-36 Gy) or focal RT (50.4-54 Gy). The rate of total and subtotal resection was 71.9%. The median follow-up for surviving patients was 121 months. RESULTS: Treatment failed in 7 patients. Three of the 5 patients who received focal RT or WBRT had local failure. Four cerebrospinal fluid (CSF) failures occurred after CSI. No failure occurred in the intermediate prognosis group. Ten-year recurrence-free survival (RFS) and overall survival (OS) for all patients were 77.6% and 74.6%, respectively. Ten-year RFS for the intermediate and poor prognosis groups were 100% and 61.1%, respectively (p = 0.012). OS for the two groups were 85.1% and 66.7%, respectively (p = 0.215). Tumor histology and CSI were significant prognostic factors for RFS, and CSI was significantly associated with OS. CONCLUSIONS: A multimodal approach was effective for treating NGGCTs. CSI should be considered for patients with poor prognostic histology
Full Text
http://www.sciencedirect.com/science/article/pii/S036030161103803X
DOI
22420971
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아청소년과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Seok(김동석)
Kim, Jun Won(김준원) ORCID logo https://orcid.org/0000-0003-1358-364X
Suh, Chang Ok(서창옥)
Shim, Kyu Won(심규원) ORCID logo https://orcid.org/0000-0002-9441-7354
Won, Sung Chul(원성철)
Lyu, Chuhl Joo(유철주) ORCID logo https://orcid.org/0000-0001-7124-7818
Cho, Jae Ho(조재호) ORCID logo https://orcid.org/0000-0001-9966-5157
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/90534
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