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Treatment Approach for Metastatic Intracranial Germinoma: A Multi-Institutional Experience.

Phoebe C Power1, Kevin X Liu2, Susan N Chi1

  • 1Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA.

Pediatric Blood & Cancer
|March 5, 2025
PubMed
Summary

Induction chemotherapy followed by reduced-dose craniospinal irradiation (CSI) offers excellent survival for metastatic germinoma. This approach may allow for a lower CSI dose, reducing long-term side effects in pediatric patients.

Keywords:
chemotherapygerm cell tumorgerminomametastaticradiation therapy

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Area of Science:

  • Pediatric Oncology
  • Radiation Oncology
  • Neuro-oncology

Background:

  • Germinoma is the most common pediatric intracranial germ cell tumor (IGCT).
  • Standard treatment involves craniospinal irradiation (CSI), but optimal approaches for metastatic disease combined with chemotherapy are unclear.
  • Recent advances show induction chemotherapy can reduce radiation therapy (RT) doses for localized germinoma.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of induction chemotherapy followed by CSI in pediatric patients with metastatic intracranial germinoma.
  • To determine if a reduced CSI dose is sufficient for curative treatment in this population.

Main Methods:

  • Retrospective study of 27 patients with metastatic intracranial germinoma (1998-2023).
  • Analysis of clinical features, treatment details (chemotherapy followed by CSI or CSI alone), and outcomes.
  • Kaplan-Meier method and Fisher's exact test were used for outcome analysis.

Main Results:

  • Twenty-seven patients with metastatic germinoma were identified, with a median age of 15.5 years.
  • Twenty-one patients received induction chemotherapy followed by CSI (median 21 Gy), while six received CSI alone.
  • No recurrences or deaths were observed in the cohort during a median follow-up of 11.3 years. High rates of endocrinopathies and CNS vasculopathy were noted.

Conclusions:

  • Pre-irradiation induction chemotherapy followed by CSI is associated with excellent survival in metastatic germinoma.
  • A reduced CSI dose of 21 Gy, when combined with induction chemotherapy, may be sufficient for cure in metastatic germinoma patients.
  • Long-term follow-up revealed significant rates of endocrinopathies and CNS vasculopathy, highlighting the need for ongoing monitoring.