Intensity-modulated ventricular irradiation for intracranial germ-cell tumors: Survival analysis and impact of salvage re-irradiation
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Ana Carolina Pires de Rezende aff001; Eduardo Weltman aff001; Michael Jenwei Chen aff003; Juliana Karassawa Helito aff001; Ícaro Thiago de Carvalho aff001; Roberto Kenji Sakuraba aff001; Nasjla Saba Silva aff004; Andrea Maria Cappellano aff004; Nelson Hamerschlak aff005
Působiště autorů:
Department of Radiation Oncology, Hospital Israelita Albert Einstein, São Paulo, Brazil
aff001; Department of Radiation Oncology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
aff002; Department of Radiation Oncology, Instituto de Oncologia Pediátrica - Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC) da Universidade Federal de São Paulo, Sao Paulo, Brazil
aff003; Department of Pediatric Oncology, Instituto de Oncologia Pediátrica - Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC) da Universidade Federal de São Paulo, São Paulo, Brazil
aff004; Department of Hematology and Clinical Oncology, Hospital Israelita Albert Einstein, São Paulo, Brazil
aff005
Vyšlo v časopise:
PLoS ONE 14(12)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0226350
Souhrn
Background and purpose
The roles of surgery, chemotherapy, and parameters of radiation therapy for treating very rare central nervous system germ cell tumors (CNS-GCT) are still under discussion. We aimed to evaluate the survival and recurrence patterns of patients with CNS-GCT treated with chemotherapy followed by whole ventricle irradiation with intensity-modulated radiation therapy.
Materials and methods
We reviewed the clinical outcomes of 20 consecutive patients with CNS-GCT treated with chemotherapy and intensity-modulated radiation therapy from 2004 to 2014 in two partner institutions.
Results
Twenty children with a median age of 12 years were included (16 males). Sixteen tumors were pure germinomas, and 4 were non-germinomatous germ cell tumors (NGGCT). All patients were treated with intensity-modulated radiation therapy guided by daily images, and 70% with volumetric intensity-modulated arc radiotherapy additionally. The median dose for the whole-ventricle was 25.2 Gy (range: 18–30.6 Gy) and 36 Gy (range: 30–54 Gy) for the tumor bed boost. The median post-radiation therapy follow-up was 57.5 months. There were 3 recurrences (2 NGGCT and 1 germinoma that recurred as a NGGCT), with 1 death from the disease and the other 2 cases each successfully rescued with chemotherapy and craniospinal irradiation. The overall survival at 5 years was 95% and disease-free survival was 85%.
Conclusions
The results of this study suggest that the combined use of chemotherapy followed by whole ventricle irradiation with intensity-modulated radiation therapy is effective for CNS-GCTs, especially pure germinomas. Even being rescued with craniospinal irradiation, the NGGCT cases have markedly worse prognoses and should be more rigorously selected for localized treatment.
Klíčová slova:
Cancer chemotherapy – Cancer treatment – Central nervous system – Cerebrospinal fluid – Germ cells – Histology – Magnetic resonance imaging – Radiation therapy
Zdroje
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