Outcome of patients with intracranial non-germinomatous germ cell tumors—lessons from the SIOP-CNS-GCT-96 trial
| العنوان: | Outcome of patients with intracranial non-germinomatous germ cell tumors—lessons from the SIOP-CNS-GCT-96 trial |
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| المؤلفون: | C. Alapetite, Didier Frappaz, Matthew J. Murray, Gabriele Calaminus, Torsten Pietsch, Maria Luisa Garrè, Jillian R. Mann, Umberto Ricardi, Ulrich Göbel, Alexandre Vasiljevic, James Nicholson, Rolf-Dieter Kortmann, Barbara Krefeld, Frank Saran |
| المصدر: | Neuro-Oncology. 19:1661-1672 |
| بيانات النشر: | Oxford University Press (OUP), 2017. |
| سنة النشر: | 2017 |
| مصطلحات موضوعية: | Male, Cancer Research, medicine.medical_treatment, chemotherapy, intracranial non-germinoma, radiotherapy, relapse, toxicity, Oncology, Neurology (clinical), 0302 clinical medicine, Antineoplastic Combined Chemotherapy Protocols, Prospective Studies, Child, Etoposide, Ifosfamide, Brain Neoplasms, Chemoradiotherapy, Neoplasms, Germ Cell and Embryonal, Prognosis, Primary tumor, Survival Rate, Child, Preschool, Lymphatic Metastasis, 030220 oncology & carcinogenesis, Female, Radiology, medicine.drug, Adult, medicine.medical_specialty, Adolescent, Clinical Investigations, Young Adult, 03 medical and health sciences, Testicular Neoplasms, Biomarkers, Tumor, medicine, Humans, Survival rate, Chemotherapy, business.industry, International Agencies, medicine.disease, Radiation therapy, Germ cell tumors, Cisplatin, Cranial Irradiation, Neoplasm Recurrence, Local, business, 030217 neurology & neurosurgery, Follow-Up Studies |
| الوصف: | Background Following promising results to increase survival and reduce treatment burden in intracranial non-germinomatous germ cell tumors (NGGCTs), we conducted a European study using dose-intense chemotherapy followed by risk-adapted radiotherapy. Methods All patients received 4 courses of cisplatin/etoposide/ifosfamide. Non-metastatic patients then received focal radiotherapy only (54 Gy); metastatic patients received 30 Gy craniospinal radiotherapy with 24 Gy boost to primary tumor and macroscopic metastatic sites. Results Patients with localized malignant NGGCT (n = 116) demonstrated 5-year progression-free survival (PFS) and overall survival (OS) of 0.72 ± 0.04 and 0.82 ± 0.04, respectively. Primary tumor sites were: 67 pineal, 35 suprasellar, 5 bifocal, 9 others. One patient died postsurgery in clinical remission; 3 patients progressed during treatment and 27 (23%) relapsed afterward. Fourteen were local, 6 combined, and 7 distant relapses (outside radiation field). Seventeen of the 27 relapsed patients died of disease. Patients with metastatic disease (n = 33) demonstrated 5-year PFS and OS of 0.68 ± 0.09 and 0.75 ± 0.08, respectively; 1 patient died following progression on treatment and 9 (27%) relapsed afterward (5 local, 1 combined, 3 distant). Only one metastatic patient with recurrence was salvaged. Multivariate analysis identified diagnostic alpha-fetoprotein level (serum and/or cerebrospinal fluid level >1000 ng/mL, 19/149 patients, of whom 11 relapsed; P < 0.0003) and residual disease following treatment, including after second-look surgery (n = 52/145 evaluable patients, 26 relapsed; P = 0.0002) as significant prognostic indicators in this cohort. Conclusion In localized malignant NGGCT, craniospinal radiotherapy could be avoided without increased relapses outside the radiotherapy field. Chemotherapy and craniospinal radiotherapy remain the gold standard for metastatic disease. |
| تدمد: | 1523-5866 1522-8517 |
| DOI: | 10.1093/neuonc/nox122 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c08b254a0da2dc1900b4b46f870af23b https://doi.org/10.1093/neuonc/nox122 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....c08b254a0da2dc1900b4b46f870af23b |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15235866 15228517 |
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| DOI: | 10.1093/neuonc/nox122 |