Radiation therapy for intracranial germinoma: Results of the German cooperative prospective trials MAKEI 83/86/89

Purpose: A multicenter prospective trial was conducted (Maligue Keimzelltum oren [MAKEI] 83/86/89) to assess outcome in intracranial germinoma after tr eatment with radiotherapy alone at reduced doses. Patients and Methods: Between 1983 and 1993, 60 patients with histologicall y (n = 58) or cytologically (n = 2) confirmed germinoma were enrolled onto the study. patients received radiotherapy alone (craniospinal axis/local bo ost). In the MAKEI 83/86 study (involving 11 patients), the dose to the cra niospinal axis was 36 Gy and the dose to the tumor region was 14 Gy. In the MAKEI 89 study (involving 49 patients), doses were 30 and 15 Gy, respectiv ely. Results: Median patient age was 13 years (range, 6 to 31 years). Complete r emission was achieved in all patients, The estimated (Kaplan-Meier) 5-year relapse-free survival rate was 91.0% +/- 3.9% at a mean fallow-up of 59.5 m onths (range, 3 to 180 months); the estimated overall survival rate was 93. 7% +/- 3.6%, Relapse occurred in five patients 10 to 33 months (mean, 18.4 months) after diagnosis (one patient developed a spinal canal metastasis an d underwent salvage radiotherapy and chemotherapy; four patients had metast ases outside the CNS and underwent salvage chemotherapy alone). Four patien ts died: one died from disease, two died from therapy-related complications , and one committed suicide. Acute complications with longlasting sequelae were tumor or surgery related (three cases of blindness, six of reduced vis ion, two of hemiparesis), psychosocial development was normal in the majori ty of patients. Conclusion: Radiotherapy directed toward the craniospinal axis or tumor sit e alone at decreased dose levels is effective. To reduce the risk of late s ide effects, further attempts to decrease total doses are justified. In cas es of recurrent disease, chemotherapy administered outside the CNS is the t reatment of choice. (C) 1999 by American Society of Clinical Oncology.