Clinical efficacy of perceived 'CNS friendly' chemoradiotherapy for primary intracranial germ cell tumours

The optimal treatment of intracranial germ cell tumours (IGCT) is controversial. The late sequelae of craniospinal radiotherapy and the high response rate to chemotherapy have led to new treatment strategies. The morbidity of combined modality therapy has tempered enthusiasm for aggressive chemoradiotherapy. In 1992, we described new lower morbidity chemotherapy and radiotherapy methods to be used in conjunction for IGCT treatment, employing three drugs (vincristine, carboplatin, etoposide) and a differential daily dose neuraxis radiotherapy technique (to replace a shrinking field technique). The chemoradiotherapy had the potential for a graded intensity reduction when high cure rates were maintained. Of 13 IGCT patients treated on this protocol, 8/8 germinomatous GCT and 3/5 non-germinomatous GCTs are in continuing remission. These observations have implications for other CNS tumour treatments in (young) patients, in whom late CNS toxicity (particularly neuropsychological) is a problem.