British Columbia Cancer, 600 W. 10th Avenue, Vancouver, BC, V5Z 4E1, Canada.
University of British Columbia, Vancouver, BC, Canada.
J Neurooncol. 2020 Sep;149(3):523-532. doi: 10.1007/s11060-020-03642-1. Epub 2020 Oct 9.
The purpose of this study is to describe the long-term toxicities of intracranial germ cell tumor (IGCT) in the adolescent and young adult (AYA) population.
We report late toxicities of a multi-center cohort of AYA patients treated for IGCT between 1975 and 2015. Charts were retrospectively reviewed for hormone deficiency, ototoxicity, seizure disorder, visual deterioration, cerebrovascular events, second neoplasm, psychiatric illness, and neurocognitive impairment. Statistical analysis was performed for late toxicities to evaluate the influence of select factors.
Our patient cohort included 112 patients with IGCTs; 84% of patients had a germinoma as opposed to a non-germinomatous germ cell tumor (NGGCT), median age at radiotherapy (RT) was 19 years, and median follow-up was 8.3 years. Of the 94 patients with germinoma, 32 (34%) received both chemotherapy and RT as part of their upfront treatment, while 62 (66%) received RT alone. All 18 patients with NGGCT received chemotherapy and RT. The most common late toxicity following IGCT treatments was physician-reported neurocognitive impairment, with a 10-year cumulative incidence (CI) of 38.5%. Ten-year CI of treatment-induced ototoxicity was 39.2% for patients who received cisplatin, compared to 3.6% for those who received carboplatin but no cisplatin (p < 0.005). Suprasellar/hypothalamic tumor location was associated with 10-year CI of treatment-induced hormone deficiency (36.1 vs 6.2%, p < 0.005).
A significant proportion of AYAs treated for IGCTs experience late effects from treatment, including neurocognitive impairment, ototoxicity, and hormone deficiency. Suprasellar/hypothalamic tumor location and cisplatin were associated with a higher risk of treatment-induced hormone deficiency and ototoxicity, respectively.
本研究旨在描述青少年和年轻成人（AYA）颅内生殖细胞肿瘤（IGCT）患者的长期毒性。
我们报告了 1975 年至 2015 年间多中心 AYA 患者 IGCT 治疗的迟发性毒性。回顾性分析了激素缺乏、耳毒性、癫痫发作、视力恶化、脑血管事件、第二肿瘤、精神疾病和神经认知障碍的图表。进行了统计学分析以评估选择因素对迟发性毒性的影响。
我们的患者队列包括 112 例 IGCT 患者；84%的患者为生殖细胞瘤，而非非生殖细胞瘤生殖细胞肿瘤（NGGCT），放疗（RT）中位年龄为 19 岁，中位随访时间为 8.3 年。32 例（34%）生殖细胞瘤患者接受了化疗和 RT 作为其初始治疗的一部分，而 62 例（66%）仅接受了 RT。18 例 NGGCT 患者均接受了化疗和 RT。IGCT 治疗后最常见的迟发性毒性是医生报告的神经认知障碍，10 年累积发生率（CI）为 38.5%。接受顺铂治疗的患者 10 年 CI 的治疗诱导性耳毒性为 39.2%，而接受卡铂但未接受顺铂的患者为 3.6%（p<0.005）。鞍上/下丘脑肿瘤部位与治疗诱导性激素缺乏的 10 年 CI 相关（36.1%比 6.2%，p<0.005）。
接受 IGCT 治疗的 AYA 中有相当一部分患者会出现治疗相关的迟发性影响，包括神经认知障碍、耳毒性和激素缺乏。鞍上/下丘脑肿瘤部位和顺铂分别与治疗诱导性激素缺乏和耳毒性的风险增加相关。
