Salvage therapy for recurrent germinomas in the central nervous system

This report presents the results of salvage therapy for 15 recurrent germinomas. The first recurrence occurred at a median of 37 months (range 6-122 months) after primary therapy. By the median follow-up period of 57 months after the first recurrence, seven of the 15 patients had died of the recurrent disease. Eleven of 15 patients who had been treated with reirradiation once achieved a complete response. Of these 11 patients, six had a second recurrence and two developed disabling radiation necrosis. Six of the 15 patients received a platinum-based chemotherapy and they also achieved a complete response. However, the remissions after chemotherapy alone were not durable. Three of the six patients received an additional low-dose (20-24 Gy) of irradiation following the chemotherapy and remained tumour-free with a performance status of more than 70%. Overall, the recurrent germinomas were consistently responsive to salvage radiation therapy and chemotherapy. However, just reirradiation or platinum-based chemotherapy alone was not sufficient to prevent a further recurrence. A low-dose of radiation therapy following chemotherapy is therefore recommended.