Preirradiation evaluation and technical assessment of involved-field radiotherapy using computed tomographic (CT) simulation and neoadjuvant chemotherapy for intracranial germinoma

Purpose: To investigate the importance of preirradiation mental and endocri nological evaluation, and the effectiveness of involved-field radiotherapy following neoadjuvant chemotherapy, Methods and Materials: Following etoposide and cisplatin with or without if osfamide, 13 patients with nondisseminated disease received involved-field irradiation of 24 Gy in 12 fractions within 3 weeks and 2 patients with dis seminated germinoma received 24 Gy craniospinal irradiation (CSI), CT simul ation was used to cover the tumor bed, Results: Full-scale intelligence quotient (IQ) tests given at the time of t he initial radiotherapy showed less than 90 in 7 of 11 patients who had tum ors involving the neurohypophyseal region, but the 4 patients who had solit ary pineal tumors showed higher scores. Panhypopituitarism was observed in 9 patients with tumors involving the neurohypophyseal region. All patients are alive without disease, with a median follow-up period of 40 months. No in-field relapse was noted after the involved-field radiotherapy. One patie nt experienced a recurrence outside of the planning target volume. Conclusion: Decline of neurocognitive and endocrine functions were often se en in patients with tumors involving the hypophyseal region, but not in pat ients with solitary pineal germinoma before radiotherapy. Involved-field ra diotherapy using 24 Gy is effective with the help of CT simulation and neoa djuvant chemotherapy. (C) 1999 Elsevier Science Inc.