RADIATION-THERAPY FOR HISTOLOGICALLY CONFIRMED PRIMARY CENTRAL-NERVOUS-SYSTEM GERMINOMA

Purpose: To evaluate survival and patterns of recurrence in patients w ith primary central nervous system germinoma treated with radiation th erapy, Methods and Materials: Data regarding 48 patients with histolog ically confirmed, primary central nervous system germinoma were review ed, All had been operated on at the Mayo Clinic between the years 1935 and 1993, Thirty-two patients (67%) were treated since 1973, The stud y group included 39 males and 9 females, with a median age at diagnosi s of 17 years (range, 6-42 years), Twelve patients (25%) were treated with craniospinal axis irradiation, 11 (23%) received whole-brain irra diation without spinal axis irradiation, and 24 (50%) underwent partia l-brain irradiation. Treatment volumes were unknown in one patient. Th e median dose to the primary tumor was 44.00 Gy (range, 7.44-59.40 Gy) , The median follow-up was 5.5 years (range, 4 months to 37 years). Re sults: Actuarial 5-year and 10-year survival for the entire study grou p of patients was 80%, There was a trend toward improved survival in p atients treated after 1973 (introduction of computed tomography) with 5-year and 10-year survival of 91% vs. 63% in prior years (p = 0.07). For the group of 31 patients treated since 1973 with known treatment v olumes, the spinal axis failure rate at 5 years was 49% for patients t reated with partial brain fields (11 patients) vs, 0% for those having undergone whole brain (10 patients) or craniospinal axis (10 patients ) irradiation (p = 0.007), The rate of brain failure was also signific antly higher in patients receiving less than whole-brain irradiation; at 5 years, 45% of the patients treated with partial-brain fields had intracranial recurrence of disease compared to 6% of patients treated with craniospinal axis or whole-brain irradiation (p = 0.01), Among th e 32 modern era patients, the rate of brain failure was higher in pati ents who received doses less than 40 Gy (median dose, 48.55 Gy; range, 30.60-59.40 Gy) to the primary tumor (5-year brain failure rate 52% v s, 11%, p = 0.002), Conclusion: The long-term survival of patients wit h histologically proven CNS germinoma treated with radiation is excell ent, Whole-brain or craniospinal axis irradiation appears to result in fewer spine and brain failures than does partial-brain irradiation, F urthermore, the administration of doses greater than 40 Gy to the prim ary tumor is associated with better local control. (C) 1997 Elsevier S cience Inc.