Improvement of Long-term Results with Neoadjuvant Chemotherapy and Radiotherapy for Central Nervous System Germinoma

OBJECTIVE: To evaluate the role of neoadjuvant chemotherapy and radiotherapy in the treatment of central nervous system germinomas in 38 patients who received definitive treatment and were followed-up >5 years between 1980 and 2009. METHODS: The median age at diagnosis and follow-up period were 16.5 years and 128.3 months, respectively. Treatment was irradiation alone or adjuvant platinum-based chemotherapy followed by reduced-dose local irradiation. Seven patients progressed at 12.9-133.9 months and 1 died of disease 89.3 months after therapy initiation. RESULTS: The treatment strategies were divided into 3 groups: group A (1980-1988, n=5), whole brain with local irradiation; group B (1989-2002, n=16), chemotherapy with or without reduced irradiation dose; and group C (2003-2009, n=17): neoadjuvant chemotherapy (3 courses) followed by 30.6 Gy of whole ventricle irradiation for patients with localized complete response, and additional local boost of 19.8 Gy for others. There were 7 recurrent cases, all in group B. The progression-free survival was significantly longer in groups A and C versus group B (P< 0.001). Decreased Karnofsky performance status was observed in 2 (40%), 6 (37.5%), and 0 cases in groups A-C, respectively. The main reasons for the good results in group C might be the neoadjuvant chemotherapy with whole ventricle radiotherapy and introduction of neuroendoscopy, especially for pineal lesions, resulting in a substantial reduction of time from the diagnosis to first treatment. CONCLUSIONS: Chemotherapy followed by whole ventricle radiotherapy, with or without local boost, and with use of neuroendoscopy results in good disease control without late complications in patients with germinomas.