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Updated: Oct 16, 2025
Quantifying Cognitive Decrements Caused by Cranial Radiotherapy
Published on: October 18, 2011
Survival outcomes, hematologic complications and growth impairment after sequential chemoradiotherapy in intracranial
Lei Wen1, Juan Li1, Mingyao Lai1
1Department of Oncology, Guangdong Sanjiu Brain Hospital, 510510, Guangzhou, China.
Purpose:
This study aimed to evaluate the clinical features, prognostic factors, and survival outcomes for patients with intracranial nongerminomatous germ cell tumors (NGGCTs), with a particular focus on treatment toxicity for long-term survivors.
Methods:
Intracranial NGGCTs treated with platinum-based chemotherapy and craniospinal irradiation (CSI) in our institution were retrospectively analyzed. Hematological complications following sequential chemoradiotherapy as well as height and weight in childhood survivors were evaluated. Plasma growth hormone (GH) concentrations prior to and after radiotherapy were obtained for the comparisons.
Results:
A total of 111 intracranial NGGCTs were included. The 3‑year overall survival (OS) and event-free survival (EFS) rates were 83.5% ± 3.9% and 71.0% ± 4.8%, respectively. A combined treatment modality consisting of ≥ 4 cycles of platinum-based chemotherapy and CSI was associated with an improved OS (P = 0.003) and EFS (P < 0.001). Thrombocytopenia of any grade occurred in 35.4% (34/96) of patients, and the threshold age for an increased risk of thrombocytopenia was 14 years (area under the curve AUC = 0.752, P < 0.0001) as derived from receiver operating characteristic (ROC) analysis. Growth impediment was found in 8 of 56 (14%) patients. The age for receiving radiotherapy was found to inversely correlate with height development, revealing a cut-off age of 11.5 years for risking growth impairment (AUC = 0.806, P = 0.004). Consistently, a significant decline in plasma growth hormone after radiotherapy was observed in patients ≤ 11.5 years (P < 0.01) but not patients > 11.5 years. (P > 0.05).
Conclusion:
Our study suggested that a combined treatment modality with at least four cycles of chemotherapy and CSI was safe and effective for patients with intracranial NGGCTs. Radiotherapy should be used with caution for patients < 11.5 years due to growth impairment.
Insights
A combined treatment of chemotherapy and craniospinal irradiation (CSI) is effective for intracranial nongerminomatous germ cell tumors (NGGCTs). Caution is advised for patients under 11.5 years undergoing radiotherapy due to potential growth impairment.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Radiation Oncology
Background:
- Intracranial nongerminomatous germ cell tumors (NGGCTs) require effective treatment strategies.
- Long-term survivors of NGGCTs may experience significant treatment toxicities.
- Understanding prognostic factors is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate clinical features and prognostic factors in patients with intracranial NGGCTs.
- To assess survival outcomes following platinum-based chemotherapy and craniospinal irradiation (CSI).
- To investigate treatment toxicity, specifically hematological complications and growth impairment, in long-term survivors.
Main Methods:
- Retrospective analysis of 111 patients with intracranial NGGCTs treated with chemotherapy and CSI.
- Evaluation of hematological complications and growth parameters (height, weight) in childhood survivors.
- Measurement of plasma growth hormone (GH) levels before and after radiotherapy.
Main Results:
- The 3-year overall survival (OS) and event-free survival (EFS) rates were 83.5% and 71.0%, respectively.
- Combined chemotherapy (≥4 cycles) and CSI improved OS and EFS (P<0.003).
- Thrombocytopenia risk increased in patients aged ≥14 years; growth impairment risk was higher in those aged <11.5 years, correlating with reduced GH post-radiotherapy.
Conclusions:
- Combined platinum-based chemotherapy and CSI is a safe and effective modality for intracranial NGGCTs.
- Radiotherapy in patients younger than 11.5 years requires caution due to the risk of growth impairment.
- Identifying age-related risks for toxicity is essential for managing long-term survivors of NGGCTs.
