Intensity-modulated ventricular irradiation for intracranial germ-cell tumors: Survival analysis and impact of salvage re-irradiation

Autoři: Ana Carolina Pires de Rezende aff001;  Eduardo Weltman aff001;  Michael Jenwei Chen aff003;  Juliana Karassawa Helito aff001;  Ícaro Thiago de Carvalho aff001;  Roberto Kenji Sakuraba aff001;  Nasjla Saba Silva aff004;  Andrea Maria Cappellano aff004;  Nelson Hamerschlak aff005
Působiště autorů: Department of Radiation Oncology, Hospital Israelita Albert Einstein, São Paulo, Brazil aff001;  Department of Radiation Oncology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil aff002;  Department of Radiation Oncology, Instituto de Oncologia Pediátrica - Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC) da Universidade Federal de São Paulo, Sao Paulo, Brazil aff003;  Department of Pediatric Oncology, Instituto de Oncologia Pediátrica - Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC) da Universidade Federal de São Paulo, São Paulo, Brazil aff004;  Department of Hematology and Clinical Oncology, Hospital Israelita Albert Einstein, São Paulo, Brazil aff005
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226350


Background and purpose

The roles of surgery, chemotherapy, and parameters of radiation therapy for treating very rare central nervous system germ cell tumors (CNS-GCT) are still under discussion. We aimed to evaluate the survival and recurrence patterns of patients with CNS-GCT treated with chemotherapy followed by whole ventricle irradiation with intensity-modulated radiation therapy.

Materials and methods

We reviewed the clinical outcomes of 20 consecutive patients with CNS-GCT treated with chemotherapy and intensity-modulated radiation therapy from 2004 to 2014 in two partner institutions.


Twenty children with a median age of 12 years were included (16 males). Sixteen tumors were pure germinomas, and 4 were non-germinomatous germ cell tumors (NGGCT). All patients were treated with intensity-modulated radiation therapy guided by daily images, and 70% with volumetric intensity-modulated arc radiotherapy additionally. The median dose for the whole-ventricle was 25.2 Gy (range: 18–30.6 Gy) and 36 Gy (range: 30–54 Gy) for the tumor bed boost. The median post-radiation therapy follow-up was 57.5 months. There were 3 recurrences (2 NGGCT and 1 germinoma that recurred as a NGGCT), with 1 death from the disease and the other 2 cases each successfully rescued with chemotherapy and craniospinal irradiation. The overall survival at 5 years was 95% and disease-free survival was 85%.


The results of this study suggest that the combined use of chemotherapy followed by whole ventricle irradiation with intensity-modulated radiation therapy is effective for CNS-GCTs, especially pure germinomas. Even being rescued with craniospinal irradiation, the NGGCT cases have markedly worse prognoses and should be more rigorously selected for localized treatment.

Klíčová slova:

Cancer chemotherapy – Cancer treatment – Central nervous system – Cerebrospinal fluid – Germ cells – Histology – Magnetic resonance imaging – Radiation therapy


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