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Br J Cancer. 1999 March; 79(7-8): 1199–1204.
PMCID: PMC2362245

Combined treatment modality for intracranial germinomas: results of a multicentre SFOP experience

E Bouffet,1 M C Baranzelli,2 C Patte,3 M Portas,4 C Edan,5 P Chastagner,6 F Mechinaud-Lacroix,7 C Kalifa,3 and on behalf of the Société Française d'Oncologie Pédiatrique


Conventional therapy for intracranial germinomas is craniospinal irradiation. In 1990, the Société Française d'Oncologie Pédiatrique initiated a study combining chemotherapy (alternating courses of etoposide–carboplatin and etoposide–ifosfamide for a recommended total of four courses) with 40 Gy local irradiation for patients with localized germinomas. Metastatic patients were allocated to receive low-dose craniospinal radiotherapy. Fifty-seven patients were enrolled between 1990 and 1996. Forty-seven had biopsy-proven germinoma. Biopsy was not performed in ten patients (four had diagnostic tumour markers and in six the neurosurgeon felt biopsy was contraindicated). Fifty-one patients had localized disease, and six leptomeningeal dissemination. Seven patients had bifocal tumour. All but one patient received at least four courses of chemotherapy. Toxicity was mainly haematological. Patients with diabetus insipidus (n = 25) commonly developed electrolyte disturbances during chemotherapy. No patient developed tumour progression during chemotherapy. Fifty patients received local radiotherapy with a median dose of 40 Gy to the initial tumour volume. Six metastatic patients, and one patient with localized disease who stopped chemotherapy due to severe toxicity, received craniospinal radiotherapy. The median follow-up for the group was 42 months. Four patients relapsed 9, 10, 38 and 57 months after diagnosis. Three achieved second complete remission following salvage treatment with chemotherapy alone or chemo-radiotherapy. The estimated 3-year survival probability is 98% (CI: 86.6–99.7%) and the estimated 3-year event-free survival is 96.4% (CI: 86.2–99.1%). This study shows that excellent survival rates can be achieved by combining chemotherapy and local radiotherapy in patients with non-metastatic intracranial germinomas. © 1999 Cancer Research Campaign

Keywords: germinoma, tumour markers, chemotherapy, local irradiation, bifocal tumour

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Selected References

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  • Allen JC, DaRosso RC, Donahue B, Nirenberg A. A phase II trial of preirradiation carboplatin in newly diagnosed germinoma of the central nervous system. Cancer. 1994 Aug 1;74(3):940–944. [PubMed]
  • Balmaceda C, Heller G, Rosenblum M, Diez B, Villablanca JG, Kellie S, Maher P, Vlamis V, Walker RW, Leibel S, et al. Chemotherapy without irradiation--a novel approach for newly diagnosed CNS germ cell tumors: results of an international cooperative trial. The First International Central Nervous System Germ Cell Tumor Study. J Clin Oncol. 1996 Nov;14(11):2908–2915. [PubMed]
  • Baranzelli MC, Patte C, Bouffet E, Couanet D, Habrand JL, Portas M, Lejars O, Lutz P, Le Gall E, Kalifa C. Nonmetastatic intracranial germinoma: the experience of the French Society of Pediatric Oncology. Cancer. 1997 Nov 1;80(9):1792–1797. [PubMed]
  • Brada M, Rajan B. Spinal seeding in cranial germinoma. Br J Cancer. 1990 Feb;61(2):339–340. [PMC free article] [PubMed]
  • Bryant WP, O'Marcaigh AS, Ledger GA, Zimmerman D. Aqueous vasopressin infusion during chemotherapy in patients with diabetes insipidus. Cancer. 1994 Nov 1;74(9):2589–2592. [PubMed]
  • Clayton PE, Shalet SM. The evolution of spinal growth after irradiation. Clin Oncol (R Coll Radiol) 1991 Jul;3(4):220–222. [PubMed]
  • Darendeliler F, Livesey EA, Hindmarsh PC, Brook CG. Growth and growth hormone secretion in children following treatment of brain tumours with radiotherapy. Acta Paediatr Scand. 1990 Oct;79(10):950–956. [PubMed]
  • Dearnaley DP, A'Hern RP, Whittaker S, Bloom HJ. Pineal and CNS germ cell tumors: Royal Marsden Hospital experience 1962-1987. Int J Radiat Oncol Biol Phys. 1990 Apr;18(4):773–781. [PubMed]
  • Göbel U, Bamberg M, Budach V, Haas RJ, Janka-Schaub G, Kühl J, Lenard HG, Rister M, Spaar HJ. Intracraniale Keimzelltumoren: Analyse der Therapiestudie MAKEI 83/86 und Protokolländerungen für die Nachfolgestudie. Klin Padiatr. 1989 Jul-Aug;201(4):261–268. [PubMed]
  • Göbel U, Bamberg M, Calaminus G, Gnekow AK, Herrmann HD, Lenard HG, Spaar HJ, Niethammer D, Kühl J, Harms D. Verbesserte Prognose intracranialer Keimzelltumoren durch intensivierte Therapie: Ergebnisse des Therapieprotokolls MAKEI 89. Klin Padiatr. 1993 Jul-Aug;205(4):217–224. [PubMed]
  • Haddock MG, Schild SE, Scheithauer BW, Schomberg PJ. Radiation therapy for histologically confirmed primary central nervous system germinoma. Int J Radiat Oncol Biol Phys. 1997 Jul 15;38(5):915–923. [PubMed]
  • Hardenbergh PH, Golden J, Billet A, Scott RM, Shrieve DC, Silver B, Loeffler JS, Tarbell NJ. Intracranial germinoma: the case for lower dose radiation therapy. Int J Radiat Oncol Biol Phys. 1997 Sep 1;39(2):419–426. [PubMed]
  • Heideman RL, Kovnar EH, Kellie SJ, Douglass EC, Gajjar AJ, Walter AW, Langston JA, Jenkins JJ, Li Y, Greenwald C, et al. Preirradiation chemotherapy with carboplatin and etoposide in newly diagnosed embryonal pediatric CNS tumors. J Clin Oncol. 1995 Sep;13(9):2247–2254. [PubMed]
  • Kiltie AE, Gattamaneni HR. Survival and quality of life of paediatric intracranial germ cell tumour patients treated at the Christie Hospital, 1972-1993. Med Pediatr Oncol. 1995 Dec;25(6):450–456. [PubMed]
  • Kobayashi T, Yoshida J, Ishiyama J, Noda S, Kito A, Kida Y. Combination chemotherapy with cisplatin and etoposide for malignant intracranial germ-cell tumors. An experimental and clinical study. J Neurosurg. 1989 May;70(5):676–681. [PubMed]
  • Linstadt D, Wara WM, Edwards MS, Hudgins RJ, Sheline GE. Radiotherapy of primary intracranial germinomas: the case against routine craniospinal irradiation. Int J Radiat Oncol Biol Phys. 1988 Aug;15(2):291–297. [PubMed]
  • Manera L, Régis J, Chinot O, Porcheron D, Levrier O, Farnarier P, Peragut JC. Pineal region tumors: the role of stereotactic radiosurgery. Stereotact Funct Neurosurg. 1996;66 (Suppl 1):164–173. [PubMed]
  • Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N, Seto T. Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg. 1997 Mar;86(3):446–455. [PubMed]
  • Mostofi FK, Sesterhenn IA, Davis CJ., Jr Developments in histopathology of testicular germ cell tumors. Semin Urol. 1988 Aug;6(3):171–188. [PubMed]
  • Mumperow E, Hartmann M. Spermatic cord beta-human chorionic gonadotropin levels in seminoma and their clinical implications. J Urol. 1992 Apr;147(4):1041–1043. [PubMed]
  • Oi S, Matsumoto S. Controversy pertaining to therapeutic modalities for tumors of the pineal region: a worldwide survey of different patient populations. Childs Nerv Syst. 1992 Sep;8(6):332–336. [PubMed]
  • Ono N, Isobe I, Uki J, Kurihara H, Shimizu T, Kohno K. Recurrence of primary intracranial germinomas after complete response with radiotherapy: recurrence patterns and therapy. Neurosurgery. 1994 Oct;35(4):615–621. [PubMed]
  • Sawamura Y, de Tribolet N, Ishii N, Abe H. Management of primary intracranial germinomas: diagnostic surgery or radical resection? J Neurosurg. 1997 Aug;87(2):262–266. [PubMed]
  • Shibamoto Y, Abe M, Yamashita J, Takahashi M, Hiraoka M, Ono K, Tsutsui K. Treatment results of intracranial germinoma as a function of the irradiated volume. Int J Radiat Oncol Biol Phys. 1988 Aug;15(2):285–290. [PubMed]
  • Shibamoto Y, Takahashi M, Abe M. Reduction of the radiation dose for intracranial germinoma: a prospective study. Br J Cancer. 1994 Nov;70(5):984–989. [PMC free article] [PubMed]
  • Shibamoto Y, Takahashi M, Sasai K. Prognosis of intracranial germinoma with syncytiotrophoblastic giant cells treated by radiation therapy. Int J Radiat Oncol Biol Phys. 1997 Feb 1;37(3):505–510. [PubMed]
  • Shinoda J, Yamada H, Sakai N, Ando T, Hirata T, Miwa Y. Placental alkaline phosphatase as a tumor marker for primary intracranial germinoma. J Neurosurg. 1988 May;68(5):710–720. [PubMed]
  • Shirato H, Nishio M, Sawamura Y, Myohjin M, Kitahara T, Nishioka T, Mizutani Y, Abe H, Miyasaka K. Analysis of long-term treatment of intracranial germinoma. Int J Radiat Oncol Biol Phys. 1997 Feb 1;37(3):511–515. [PubMed]
  • Sung DI, Harisiadis L, Chang CH. Midline pineal tumors and suprasellar germinomas: highly curable by irradiation. Radiology. 1978 Sep;128(3):745–751. [PubMed]
  • Uematsu Y, Tsuura Y, Miyamoto K, Itakura T, Hayashi S, Komai N. The recurrence of primary intracranial germinomas. Special reference to germinoma with STGC (syncytiotrophoblastic giant cell). J Neurooncol. 1992 Jul;13(3):247–256. [PubMed]
  • Wolden SL, Wara WM, Larson DA, Prados MD, Edwards MS, Sneed PK. Radiation therapy for primary intracranial germ-cell tumors. Int J Radiat Oncol Biol Phys. 1995 Jul 15;32(4):943–949. [PubMed]

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