CHEMOTHERAPY WITHOUT IRRADIATION - A NOVEL-APPROACH FOR NEWLY-DIAGNOSED CNS GERM-CELL TUMORS - RESULTS OF AN INTERNATIONAL COOPERATIVE TRIAL

Purpose: Radiation therapy for CNS germ cell tumors (GCT) is commonly associated with neurologic sequelae. We designed a therapeutic trial t o determine whether irradiation could be avoided. Patients and Methods : Patients received four cycles of carboplatin, etoposide, and bleomyc in. Those with a complete response (CR) received two further cycles; o thers received two cycles intensified by cyclophosphamide. Results: Se venty-one patients were enrolled (45 with germinoma and 26 with nonger minomatous GCT [NGGCT]). Sixty-eight were assessable for response. Thi rty-nine of 68 (57%) achieved a CR within four cycles. Of 29 patients with less than a CR, 16 achieved CR with intensified chemotherapy or s econd surgery. Overall, 55 of 71 (78%) achieved a CR without irradiati on. The CR rate was 84% for germinomas and 78% for NGGCT. With a media n follow-up duration of 31 months, 28 of 71 patients were alive withou t relapse or progression. Thirty-five showed tumor recurrence (n=28) o r progression (n=7) at a median of 13 months. Twenty-six of 28 patient s (93%) who recurred following remission underwent successful salvage therapy. pathology was the only variable predictive of survival. The p robability of surviving 2 years was .84 for germinoma patients and .62 for NGGCT. Seven of 71 patients died of toxicity associated with stud y chemotherapy.Conclusion: Forty-one percent of surviving patients and 50% of all patients were treated successfully with chemotherapy only without irradiation, Chemotherapy-only regimens for CNS GCT, although encouraging, should continue to be used only in the setting of formal clinical trials. (C) 1996 by American Society of Clinical Oncology.