Department of Pathology, University of Cambridge, Cambridge, UK.
Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Pediatr Blood Cancer. 2022 Jan;69(1):e29359. doi: 10.1002/pbc.29359. Epub 2021 Sep 14.
Patients with localized intracranial germinoma have excellent survival. Reducing treatment burden and long-term sequelae is a priority. Intensive inpatient chemotherapy (e.g., carboPEI = carboplatin/etoposide/ifosfamide) has been effectively employed to reduce radiotherapy treatment volume/dose. Outpatient-based carboplatin monotherapy is associated with excellent outcomes in metastatic testicular seminoma (an identical pathology), and successful vinblastine monotherapy induction (with 77% tumor volume reduction after just two weekly vinblastine doses) has recently been reported in an intracranial germinoma patient.
Adapted UK guidelines for germ cell tumor management were distributed during the COVID-19 pandemic, including nonstandard treatment options to reduce hospital visits and/or admissions. This included vinblastine monotherapy for intracranial germinoma (6 mg/m intravenously, or 4 mg/m for moderate count suppression, delivered weekly). We describe two such patients treated using this approach.
A 30-year-old male with a localized pineal tumor received 12-week vinblastine induction, with >60% volume reduction, prior to definitive radiotherapy. A 12-year-old female with a metastatic suprasellar tumor and progression at all sites of disease whilst awaiting proton radiotherapy received two vinblastine doses with good early response, including 36% primary tumor volume reduction. The patients tolerated vinblastine well.
Patients with intracranial germinoma have excellent outcomes, and reduction of late effects remains a priority. The description of vinblastine monotherapy in these intracranial germinoma patients warrants further exploration.
局限性颅内生殖细胞瘤患者的生存率很高。降低治疗负担和长期后遗症是当务之急。强化住院化疗（如卡铂依托泊苷异环磷酰胺[carboPEI]）已被有效地用于减少放疗治疗体积/剂量。基于门诊的卡铂单药治疗在转移性睾丸精原细胞瘤（一种相同的病理）中具有良好的疗效，最近有报道称，在颅内生殖细胞瘤患者中，长春碱单药诱导治疗（仅用两剂每周长春碱即可使肿瘤体积缩小 77%）取得了成功。
在 COVID-19 大流行期间，分发了适用于生殖细胞瘤管理的英国指南，包括减少医院就诊和/或住院次数的非标准治疗选择。这包括对颅内生殖细胞瘤采用长春碱单药治疗（6mg/m 静脉注射，或中度白细胞减少时 4mg/m，每周一次）。我们描述了采用这种方法治疗的两名患者。
一名 30 岁的男性患者，松果体局部肿瘤，在接受确定性放疗前接受了 12 周的长春碱诱导治疗，肿瘤体积缩小了>60%。一名 12 岁的女性患者，患有转移性鞍上肿瘤，在等待质子放疗期间，所有部位的疾病均进展，在接受两剂长春碱后，早期反应良好，包括原发肿瘤体积缩小 36%。患者对长春碱耐受良好。
颅内生殖细胞瘤患者的预后良好，降低迟发性效应仍然是当务之急。长春碱单药治疗在这些颅内生殖细胞瘤患者中的描述值得进一步探索。
