Treatment and outcomes of UK and German patients with relapsed intracranial germ cell tumors following uniform first‐line therapy. Issue 3 (15th May 2017)

• Record Type: Journal Article
• Authors: Murray, Matthew J.; Bailey, Shivani; Heinemann, Katja; Mann, Jillian; Göbel, Ulrich K; Saran, Frank; Hale, Juliet P.; Calaminus, Gabriele; Nicholson, James C.
• Is Part Of: International journal of cancer. Volume 141:Issue 3(2017:Aug. 01)
• Page Start: 621
• Page End: 635
• Publication Date: 2017-05-15
• Subjects: germ cell tumor -- high‐dose chemotherapy -- intracranial -- non‐germinoma -- relapse -- re‐irradiation; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.30755
• Languages: English
• ISSNs: 0020-7136

Abstract

Abstract : We aimed to retrospectively assess treatments/outcomes, including the value of high‐dose‐chemotherapy and autologous‐stem‐cell‐rescue (HDC + AuSCR) and re‐irradiation, in a large, European patient‐cohort with relapsed intracranial germ‐cell‐tumors (GCTs) receiving uniform first‐line therapy, including radiotherapy as standard‐of‐care. Fifty‐eight UK/German patients (48 male/10 female) with relapsed intracranial‐GCTs [13 germinoma/45 non‐germinomatous GCT (NGGCT)] treated 1996–2010 as per the SIOP‐CNS‐GCT‐96 protocol were evaluated. For germinoma, six patients relapsed with germinoma and five with NGGCT (one palliative, one teratoma patient excluded). Five‐year overall‐survival (OS) for the whole‐group ( n = 11) was 55%. Four of six germinoma relapses and two of five relapsing with NGGCT were salvaged; patients were salvaged with either standard‐dose‐chemotherapy (SDC) and re‐irradiation or HDC + AuSCR with/without re‐irradiation. Of 45 relapsed NGGCT patients, 13 were excluded (three non‐protocol adherence, five teratoma, five palliation). Five‐year OS for the remaining 32 relapsed malignant NGGCT patients treated with curative intent was 9% (95%CI: 2–26%). By treatment received, 5‐year OS for the 10 patients receiving SDC and 22 patients treated with intention for HDC + AuSCR was 0% (0–0%) and 14% (3–36%), respectively. The three relapsed NGGCT survivors had raised HCG markers alone; two received additional irradiation. Patients with relapsed germinoma had better 5‐year OS than those with relapsed NGGCT (55 vs . 9%; p = 0.007). Patients with relapsed germinoma were salvaged both with SDC and re‐irradiation or HDC + AuSCR with/without re‐irradiation; both represent valid treatment options. Outcomes for malignant relapse following initial diagnosis of NGGCT were exceptionally poor; the few survivors received thiotepa‐based HDC + AuSCR, which is a treatment option at first malignant relapse for such patients, with further surgery/irradiation where feasible. Abstract : What's new? What's the optimal approach to treating a certain type of relapsed brain tumor? The authors looked at a rare type of cancer called intracranial germ cell tumors (GCTs), which fall into two categories, germinomas and non‐germinomatous tumors. They evaluated data from 58 European patients, the largest cohort of relapsed GCTs studied to date, all of whom received uniform first‐line treatment. Patients with relapsed germinoma could survive after standard‐dose chemotherapy with additional radiotherapy or high‐dose chemotherapy plus autologous‐stem‐cell‐rescue (HDC + AuSCR), with or without additional radiotherapy. Those who relapsed with non‐germinomatous GCTs had a poor prognosis; only those receiving HDC + AuSCR had any possibility of cure.