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Published on: March 28, 2021
Optimal treatment approach for intracranial germinoma: a systematic review and meta-analysis
Zhirui Zhou1,2,3, Jiabing Liu4,5, Qi Yue5,6
1Radiation Oncology Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040, China. zzr3711@163.com.
Background:
To determine the optimal treatment modality for intracranial germinoma (IG).
Materials And Methods:
A search of Medline, Embase, Web of Science and Cochrane Library was conducted up to April, 2024. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated. Subgroup analysis was applied according to radiotherapy (RT) alone or with chemotherapy (CTx).
Results:
Total 37 studies were included in systematic review. Most IG patients were treated with biopsy or resection followed by RT with or without CTx. Prognosis of IG patients with different surgical resection is similar. Meta-analyses demonstrated focal field RT were with higher recurrence rate compared with craniospinal irradiation (CSI) [RR = 7.128, 95% CI (5.083, 9.995)], whole-brain RT (WBRT) [RR = 4.094, 95% CI (2.923, 5.735)] or whole-ventricle RT (WVRT) [RR = 3.361, 95% CI (2.126, 5.312)]; both WBRT and WVRT were also with higher recurrence compared with CSI; but no significant difference in recurrence and mortality between WVRT and WBRT. Total 24 studies reported treatment-related acute and/or late toxicity, combination CTx increased acute toxic, and expanded RT field and/or dose increased late toxicity.
Conclusion:
Based on our findings, focal field RT is not recommended regardless of whether combined with CTx for intracranial pure germinoma. Although CSI is associated with better local control than other reduced-field RT, considering the potential toxicity and pattern of relapse, whole ventricles irradiation is more reasonable for localized or nonmetastatic germinoma. Reduced-dose CSI with or without chemotherapy is effective in metastatic or disseminated IG.
Insights
Focal field radiotherapy is not recommended for intracranial germinoma. Whole ventricles irradiation offers better local control than reduced-field radiotherapy for localized disease, while reduced-dose craniospinal irradiation is effective for metastatic germinoma.
Area of Science:
- Neuro-oncology
- Radiation oncology
- Pediatric oncology
Background:
- Intracranial germinoma (IG) treatment requires optimal modality selection.
- Understanding treatment efficacy and toxicity is crucial for patient outcomes.
Approach:
- Systematic review and meta-analysis of 37 studies.
- Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated.
- Subgroup analysis compared radiotherapy (RT) alone versus RT with chemotherapy (CTx).
Key Points:
- Focal field RT showed higher recurrence rates than craniospinal irradiation (CSI), whole-brain RT (WBRT), or whole-ventricle RT (WVRT).
- WBRT and WVRT had higher recurrence than CSI, with no significant difference between WBRT and WVRT.
- Combination CTx increased acute toxicity; expanded RT fields/doses increased late toxicity.
Conclusions:
- Focal field RT is not recommended for intracranial pure germinoma.
- Whole ventricles irradiation is a reasonable option for localized/nonmetastatic germinoma, balancing local control and toxicity.
- Reduced-dose CSI with or without chemotherapy is effective for metastatic/disseminated IG.
