Germinoma secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

Secondary prevention strategies following germinoma include retreatment with the original regimen. For patients who received radiotherapy RT to a reduced volume, craniospinal irradiation CSI is considered the standard of care. Myeloablative high-dose chemotherapy with autologous stem cell rescue followed by additional RT can be considered, for patients who have already received craniospinal irradiation CSI.[1]

Secondary Prevention

  • In majority of patients recurrences are commonly encountered in those who received neoadjuvant chemotherapy and a reduced dose of RT. The majority of these patients can be recovered with radiation with or without chemotherapy.
  • As the majority of recurrent germinomas remain sensitive to chemotherapy, therefore retreatment with the original regimen is a viable strategy to reinduce a complete remission. For patients who received radiotherapy RT to a reduced volume, craniospinal irradiation CSI is considered the standard of care.
  • Myeloablative high-dose chemotherapy with autologous stem cell rescue followed by additional RT can be considered, for patients who have already received craniospinal irradiation CSI. However, the prognosis for patients with recurrent intracranial NGGCTs is poor as nearly all will have received chemotherapy and radiotherapy RT as their initial treatment.[2][3][4][5][6][7][8][9][1]

References

  1. 1.0 1.1 Baek HJ, Park HJ, Sung KW, Lee SH, Han JW, Koh KN; et al. (2013). "Myeloablative chemotherapy and autologous stem cell transplantation in patients with relapsed or progressed central nervous system germ cell tumors: results of Korean Society of Pediatric Neuro-Oncology (KSPNO) S-053 study". J Neurooncol. 114 (3): 329–38. doi:10.1007/s11060-013-1188-1. PMID 23824533.
  2. Goldman, S.; Bouffet, E.; Fisher, P. G.; Allen, J. C.; Robertson, P. L.; Chuba, P. J.; Donahue, B.; Kretschmar, C. S.; Zhou, T.; Buxton, A. B.; Pollack, I. F. (2015). "Phase II Trial Assessing the Ability of Neoadjuvant Chemotherapy With or Without Second-Look Surgery to Eliminate Measurable Disease for Nongerminomatous Germ Cell Tumors: A Children's Oncology Group Study". Journal of Clinical Oncology. 33 (22): 2464–2471. doi:10.1200/JCO.2014.59.5132. ISSN 0732-183X.
  3. Calaminus, G.; Kortmann, R.; Worch, J.; Nicholson, J. C.; Alapetite, C.; Garre, M. L.; Patte, C.; Ricardi, U.; Saran, F.; Frappaz, D. (2013). "SIOP CNS GCT 96: final report of outcome of a prospective, multinational nonrandomized trial for children and adults with intracranial germinoma, comparing craniospinal irradiation alone with chemotherapy followed by focal primary site irradiation for patients with localized disease". Neuro-Oncology. 15 (6): 788–796. doi:10.1093/neuonc/not019. ISSN 1522-8517.
  4. Alapetite C, Brisse H, Patte C, Raquin MA, Gaboriaud G, Carrie C; et al. (2010). "Pattern of relapse and outcome of non-metastatic germinoma patients treated with chemotherapy and limited field radiation: the SFOP experience". Neuro Oncol. 12 (12): 1318–25. doi:10.1093/neuonc/noq093. PMC 3018943. PMID 20716594.
  5. da Silva NS, Cappellano AM, Diez B, Cavalheiro S, Gardner S, Wisoff J; et al. (2010). "Primary chemotherapy for intracranial germ cell tumors: results of the third international CNS germ cell tumor study". Pediatr Blood Cancer. 54 (3): 377–83. doi:10.1002/pbc.22381. PMID 20063410.
  6. Calaminus, Gabriele, et al. "SIOP CNS GCT 96: final report of outcome of a prospective, multinational nonrandomized trial for children and adults with intracranial germinoma, comparing craniospinal irradiation alone with chemotherapy followed by focal primary site irradiation for patients with localized disease." Neuro-oncology 15.6 (2013): 788-796.
  7. Mahoney DH, Strother D, Camitta B, Bowen T, Ghim T, Pick T; et al. (1996). "High-dose melphalan and cyclophosphamide with autologous bone marrow rescue for recurrent/progressive malignant brain tumors in children: a pilot pediatric oncology group study". J Clin Oncol. 14 (2): 382–8. PMID 8636747.
  8. Modak S, Gardner S, Dunkel IJ, Balmaceda C, Rosenblum MK, Miller DC; et al. (2004). "Thiotepa-based high-dose chemotherapy with autologous stem-cell rescue in patients with recurrent or progressive CNS germ cell tumors". J Clin Oncol. 22 (10): 1934–43. doi:10.1200/JCO.2004.11.053. PMID 15143087.
  9. Bouffet E (2010). "The role of myeloablative chemotherapy with autologous hematopoietic cell rescue in central nervous system germ cell tumors". Pediatr Blood Cancer. 54 (4): 644–6. doi:10.1002/pbc.22376. PMID 20146220.

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