NONMETASTATIC INTRACRANIAL GERMINOMA - THE EXPERIENCE OF THE FRENCH-SOCIETY-OF-PEDIATRIC-ONCOLOGY

BACKGROUND. Standard treatment of localized intracranial germinoma is focal irradiation of the primary tumor (45-50 grays [Gy]) combined wit h craniospinal radiotherapy (RT). To decrease late effects related to extensive fields of RT, the French Society of Pediatric Oncology decid ed in 1990 to replace prophylactic RT with chemotherapy (CT) and to de liver focal RT at 40 Gy. METHODS. Twenty-nine patients with localized, biopsy proven germinoma were included in this study between January 1 990 and December 1994. CT consisted of 2 cycles of carboplatin 600 mg/ m(2) on Day 1, etoposide 150 mg/m(2) on Days 1-3, ifosfamide 1.8 g/m(2 ) on Days 22-26, and etoposide 150 mg(2) on Days 22-24, followed by RT delivered to the initial tumor volume (40 Gy). RESULTS. The median ag e of the 19 boys and 10 girls was 12.8 years; 25 patients had a unifoc al tumor in the pineal (13), suprasellar (10), or thalamic (2) area, a nd 4 patients had a bifocal tumor. Three patients initially had comple te surgery. Of the 26 patients evaluable for CT response, 11 had a sma ll amount of tumor residue and 15 no residue; no patient underwent sur gery after CT or RT. One patient recurred 3 years after diagnosis and is in his second complete remission. Twenty-eight patients are in thei r first complete remission after a median follow-up of 32 months (rang e, 7-68 months); 9 of the 28 have a small amount of tumor residue that is considered nonevolving. Overall survival at 4 years is 100% and ev ent free survival is 93.3% (+/- 6%) after a median follow-up of 32 mon ths. CONCLUSIONS. This treatment strategy avoids craniospinal RT and r educes focal RT, with results equivalent to those achieved with extens ive RT. Thus, the authors consider it a valid treatment of nonmetastat ic germinoma. (C) 1997 American Cancer Society.