Outcome of central nervous system germinoma treatment by chemoradiation

Central nervous system germinoma historically has been treated with radiotherapy alone. Although this regimen provides good tumor control, there are risks of long-term complications; this study used a combination of chemotherapy and low-dose radiotherapy to reduce these risks. Between January 2002 and June 2009, 16 patients (14 male, 2 female) with a median age of 14.7 years (9.2 to 19.6 y), were treated. Thirteen of the tumors had a single focus and 3 were multifocal: 8 were located in the pineal, 8 were suprasellar, and 3 were in the basal ganglion or other periventricular areas. All patients had negative spinal magnetic resonance imaging findings. Treatment consisted of cisplatin-based and etoposide-based chemotherapy, and 2340 cGy of radiotherapy delivered to the whole brain/ventricle. The median time of follow-up was 45 months. None of the patients suffered from treatment failure. Tumors larger than 2.5 cm regressed less completely after upfront chemotherapy than smaller tumors, but overall treatment outcome was not affected by tumor size. One patient developed a new complication (hypopituitarism) 8 months after treatment, and 1 patient developed a second malignancy 3 years after diagnosis. The results confirm that short courses of chemotherapy combined with low-dose whole-brain or whole-ventricular radiotherapy have favorable outcomes.