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Cancer Research and Treatment > Accepted Articles
doi: https://doi.org/10.4143/crt.2020.1052    [Accepted]
Long-Term Outcomes and Sequelae Analysis of Intracranial Germinoma: Need to Reduce the Extended-Field Radiotherapy Volume and Dose to Minimize Late Sequelae
Joo Ho Lee1,2, Keun-Yong Eom3, Ji Hoon Phi4, Chul-Kee Park4, Seung Ki Kim4, Byung-Kyu Cho5, Tae Min Kim6, Dae Seog Heo6, Kyung Taek Hong7, Jung Yoon Choi7, Hyoung Jin Kang7, Hee Young Shin7, Seung Hong Choi8, Soon Tae Lee9, Sung Hye Park10, Kyu-Chang Wang11, Il Han Kim1
1Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
2Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
3Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
4Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
5Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea
6Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
7Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
8Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
9Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
10Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
11Department of Neurosurgery, National Cancer Center, Goyang, Korea
Correspondence  Kyu-Chang Wang ,Tel: 82-31-920-0889, Fax: 82-31-920-2799, Email: kcwang@snu.ac.kr
Il Han Kim ,Tel: 82-2-2072-2819, Fax: 82-2-2072-2073 , Email: ihkim@snu.ac.kr
Received: October 14, 2020;  Accepted: January 8, 2021.  Published online: January 13, 2021.
ABSTRACT
Purpose
We aimed to refine the radiotherapy (RT) volume and dose for intracranial germinoma considering recurrences and long-term toxicities.
Materials and Methods
Total 189 patients with intracranial germinoma were treated with RT alone (n=50) and RT with upfront chemotherapy (CRT) (n=139). All cases were confirmed histologically. RT fields comprised the extended-field and involved-field only for primary site. The extended-field, including craniospinal, whole-brain (WB), and whole-ventricle (WV) for cranial field, is followed by involved-field boost. The median follow-up duration was 115 months.
Results
The relapses developed in 13 patients (6.9%). For the extended-field, cranial RT dose down to 18 Gy exhibited no cranial recurrence in 34 patients. In CRT, 74 patients (56.5%) showed complete response to chemotherapy and no involved-field recurrence with low-dose RT of 30 Gy. WV RT with chemotherapy for the basal ganglia or thalamus germinoma showed no recurrence. Secondary malignancy developed in ten patients (5.3 %) with a latency of 20 years (range, 4–26) and caused mortalities in six. WB or craniospinal field rather than WV or involved-field significantly increased the rate of hormone deficiencies, and secondary malignancy. RT dose for extended-field correlated significantly with the rate of hormone deficiencies, secondary malignancy, and neurocognitive dysfunction.
Conclusion
Reduced dose and volume of extended-field rather than total dose or involved-field will be critical to decrease the late toxicities. Upfront chemotherapy could be beneficial for the patients with complete response to minimize the RT dose down to 30 Gy. Prospective trials focused on de-intensification of the extended-field RT are warranted.
Key words: Germinoma, Radiotherapy, Radiation toxicity, Radiation-Induced Cancer
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