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

Conventional therapy for intracranial germinomas is craniospinal irradiatio n. In 1990, the Societe Francaise d'Oncologie Pediatrique initiated a study combining chemotherapy (alternating courses of etoposide-carboplatin and e toposide-ifosfamide for a recommended total of four courses) with 40 Gy loc al irradiation for patients with localized germinomas. Metastatic patients were allocated to receive low-dose craniospinal radiotherapy. Fifty-seven p atients were enrolled between 1990 and 1996. Forty-seven had biopsy-proven germinoma. Biopsy was not performed in ten patients (four had diagnostic tu mour markers and in six the neurosurgeon felt biopsy was contraindicated), Fifty-one patients had localized disease, and six leptomeningeal disseminat ion. Seven patients had bifocal tumour. All but one patient received at lea st four courses of chemotherapy Toxicity was mainly haematological, Patient s with diabetus insipidus (n = 25) commonly developed electrolyte disturban ces during chemotherapy. No patient developed tumour progression during che motherapy, Fifty patients received local radiotherapy with a median dose of 40 Gy to the initial tumour volume. Six metastatic patients, and one patie nt 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 c hemotherapy alone or chemo-radiotherapy, The estimated 3-year survival prob ability is 98% (CI, 86.6-99.7%) and the estimated 3-year event-free surviva l 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 patien ts with non-metastatic intracranial germinomas.