Abstract
Among intracranial germ cell tumors, nongerminomatous tumors have proved refractory to conventional treatment with surgery and irradiation. The median survival is less than 2 years. Since 1983, chemotherapy has been delivered in Japan as an adjuvant therapy in patients with intracranial nongerminomatous germ cell tumors. Based on our clinical experience, we undertook a multi-institutional phase II study to establish post-surgical combined chemotherapy and radiation therapy for primary germ cell tumors in the brain. We adopted carboplatin-etoposide (CARB-VP) or cisplatin-etoposide (PE) combination chemotherapy for patients with germinomas and those with tumors that placed them in the intermediate prognosis group, and ifosphamide-cisplatin-etoposide (ICE) for patients with tumors that placed them in the poor prognosis group. One hundred and twelve patients were evaluated. Among patients with germinoma (n = 75), the rate or complete remission after combination therapy was 92.0%; it was 67.8% for patients in the intermediate prognosis group (n = 28). Tumor recurrence was noted in 9 patients with germinoma and 2 patients in the intermediate prognosis group. Of 9 patients with a poor prognosis, 4 experienced disease progression during treatment and died within 10 months. There were no serious complications attributable to the combination therapy. Our treatment protocols are effective for patients with germinomas and those with an intermediate prognosis.
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Dattoli MF, Newall J: Radiation therapy for intracranial germinoma: the case for limited volume treatment. Int J Radiat Oncol Biol Phys 19: 429–433, 1990
Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N, Seto T: Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg 86: 446–455, 1997
Schulte FJ, Hermann HD, Muller D, Franke H, Saeger W, Spaar FW, Bartels S: Pineal region tumours of childhood. Eur J Pediat 146: 233–245, 1987
Jenkin D, Berry M, Chan H, Greenberg M, Hendrick B, Hoffman H, Humphereys R, Sonley M, Weitzman S: Pineal region germinomas in childhood. Treatment considerations. Int J Radiat Oncol Biol Phys 18: 541–545, 1990
Matsutani M, Sano K, Takakura K: Long-term follow-up of patients with primary intracranial germinomas. In: Packer R, Bleyer WL, Pochedly C (eds) Pediatric Neuro-Oncology. Harwood Academic Pub., 1992, pp 254–260
Jennings MT, Gelman R, Hochberg F: Intracranial germcell tumors: natural history and pathogenesis. J Neurosurg 63: 155–167, 1985
Matsukado Y, The Japanese Intracranial Germ Cell Tumor Study Group: Cisplatin, vinblastine, bleomycin (PVB) combination chemotherapy in the treatment of intracranial malignant germ cell tumors - a preliminary report of phase II study. Jpn J Cancer Clin 32: 1387–1393, 1986 (in Japanese)
Bosl GJ, Yagoda A, Whitmore WF, Sogani P, Herr H, Tugrin D, Dukeman M, Golbey R: VP-16-213 and cisplatin in the treatment of patients with refractory germ cell tumours. Am J Clin Oncol 7: 327–330, 1984
Einhorn LH, Donohue J: Cis-diamminedichloroplatinum, vinblastine, and bleomycin combination chemotherapy in disseminated testicular cancer. Ann Intern Med 87: 293–298, 1977
Yoshida J, Sugita K, Kobayashi K, Shitara N, Matsutani M, Tanaka R, Nagai H, Yamada H, Yamashita J, Oda Y, Hayakawa T, Ushio Y: Prognosis of intracranial germ cell tumours: effectiveness of chemotherapy with cisplatin and etoposide (CDDP and VP-16). Acta Neurochir (Wien) 120: 111–117, 1993
Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O: Combined treatment with chemotherapy and radiation therapy for intracranial germ cell tumors. Child's Nerv Syst 14: 59–62, 1998
Matsutani M, Ushio Y, Abe H, Yamashita J, Shibui S, Fujimaki T, Takakura K, Nomura K, Tanaka R, Fukui M, Yoshimoto T, Hayakawa T, Nagahsima T, Kurisu K, Kayama T: Combined chemotherapy and radiation therapy for central nervous system germ cell tumors: preliminary results of a Phase II study of the Japanese Pediatric Brain Tumor Study Group. Neurosurg Focus 5: Article 7, 1998
Rappaport R, Brauner R: Growth and endocrine disorders secondary to cranial irradiation. Pediat Res 25: 561–567, 1989
Shibamoto Y, Abe Y, Yamashita J, Takahashi M, Hiraoka M, Ono K, Tsutsui K: Treatment result of intracranial germinoma as a function of the irradiated volume. Int J Radiat Oncol Biol Phys 15: 285–290, 1998
Sawamura Y, Shirato H, Ikeda J, Tada M, Ishii N, Kato T, Abe H, Fujieda K: Induction chemotherapy followed by 316 reduced-volume radiation therapy for newly diagnosed central nervous system germinoma. J Neurosurg 88: 66–72, 1998
Balmaceda C, Heller G, Rosenblum M, Diez B, Villablanca JG, Kellie S, Maher P, Vlamis V, Walker RW, Leibel S: Chemotherapy without irradiation - A novel approach for newly diagnosed CNS germ cell tumors: results of an international cooperative trial. J Clin Oncol 14: 2908–2915, 1996
Sugiyama K, Uozumi T, Arita K, Kiya K, Kurisu K, Sumida M, Harada K: Clinical evaluation of 33 patients with histologically verified germinoma. Surg Neurol 42: 200–210, 1994
Uematsu Y, Tsuura Y, Itakura T, Hayashi S, Komai N: The recurrence of primary intracranial germinomas. Special reference to germinoma with STGC (syncytiotrophoblastic giant cells). J Neuro-Oncol 13: 247–256, 1992
Allen JC, Bosl G, Walker R: Chemotherapy trials in recurrent primary intracranial germ cell tumors. J Neuro-Oncol 3: 147–152, 1985
Chang CG, Kageyama N, Kobayashi T, Yoshida J, Negoro M: Pineal tumors: clinical diagnosis, with special emphasis on the significance of pineal calcification. Neurosurgery 8: 656–668, 1981
Fults D, Kelly DL Jr: A suprasellar atypical teratoma presenting as an intrasellar mass: a case report. Neurosurgery 13: 40–43, 1983
Nakamura Y, Sato Y, Nishimura G, Tanimura A, Takahashi Y, Hachisuka H, Masaike K, Yanai T, Hashimoto H: Malignant teratoma in the brain. An immunohistochemical study. Cancer 55: 103–107, 1985
Ng HK, Poon WS, Chan YL: Basal ganglia teratomas: report of three cases. Aust N Z J Surg 62: 436–440, 1992
Preissig SH, Smith MT, Huntington HW: Rhabdomyosarcoma arising in pineal teratoma. Cancer 44: 281–284, 1979
Sakata K, Yamada H, Sakai N, Hosmo Y, Kawasaki T, Sasaoka I: Extraneural metastasis of pineal tumor. Surg Neurol 3: 49–54, 1975
Samii M, Ramina R, Koch G, Reusche E: Malignant teratoma of the optic nerve: case report. Neurosurgery 16: 696–700, 1985
Shokry A, Janzer RC, von Hochstetter AR, Yasargil M, Hedinger C: Primary intracranial germ-cell tumors. A clinicopathological study of 14 cases. J Neurosurg 62: 826–830, 1985
Simson LR, Lample I, Abell MR: Suprasellar germinomas. Cancer 22: 533–544, 1968
Tajika Y, Kubo O, Himuro H, Inoue N, Kamiya M, Honami T, Toyama T, Yoshida N, Kitamura K: Clinico-pathological features of intracranial germ cell tumors with dissemination or metastasis in childhood. Neurol Surg 12: 161–168, 1984
Ushio, Y, Kochi M, Kuratsu J, Itoyama Y, Tarubayashi T: Preliminary observations for a new treatment in children with primary intracranial yolk sac tumor or embryonal carcinoma. Report of 5 cases. J Neurosurg 90: 133–137, 1999
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The following neurosurgical departments contributed in the Japanese Pediatric Brian Tumor Study Group: Hokkaido University Hospital, Tohoku University Hospital, Yamagata University Hospital, Tokyo University Hospital, Saitama Medical School Hospital, National Cancer Center Hospital, Niigata University Hospital, Kanazawa University Hospital, Osaka University Hospital, Hiroshima University Hospital, Kyushu University Hospital, and Kumamoto University Hospital
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Matsutani, M., The Japanese Pediatric Brain Tumor Study Group Combined chemotherapy and radiation therapy for CNS germ cell tumors – the Japanese experience. J Neurooncol 54, 311–316 (2001). https://doi.org/10.1023/A:1012743707883
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DOI: https://doi.org/10.1023/A:1012743707883