Salvage radiation therapy for intracranial germinoma recurring after primary chemotherapy

Systemic chemotherapy has been increasingly used in the primary treatment o f intracranial germinoma. However, the recurrence rate seems to be very hig h after treatment with chemotherapy alone. We used radiation to treat 5 pat ients harboring intracranial germinoma that recurred following primary chem otherapy. They had received systemic chemotherapy (4 with cisplatin plus et oposide and 1 with adriamycin, vincristine, cyclophosphamide, prednisolone, and cisplatin) 7-24 months before referral. All patients were treated with conventional radiotherapy directed to the primary tumor site or the cranio spinal axis with a dose to the primary site ranging from 39.6 to 47.0 Gy (m ean, 42.6 Gy). Response to radiation of all the recurrent tumors was good a nd all tumors disappeared on diagnostic imaging below the dose of 24 Gy. Al l patients are alive without further recurrence at 61-129 months after salv age radiotherapy. Germinomas recurring after primary chemotherapy do not se em to have acquired cross resistance to radiotherapy. They can usually be c ured by standard radiation therapy with 40-47 Gy.