Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
Department of Radiation Oncology, National Cancer Centre, Singapore, Singapore.
Neuro Oncol. 2022 Aug 1;24(8):1389-1399. doi: 10.1093/neuonc/noab295.
This multinational study was conducted to report clinical presentations and treatment strategies in patients with intracranial germinomas across selected Asian centers, including failure patterns, risk factors, and outcomes.
A retrospective data collection and analysis of these patients, treated between 1995 and 2015 from eight healthcare institutions across four countries was undertaken.
From the results, 418 patients were analyzed, with a median follow-up of 8.9 years; 79.9% of the patients were M0, and 87.6% had β-human chorionic gonadotropin values <50 mIU/mL. The 5/10-year overall survival (OS) and recurrence-free survival (RFS) rates were 97.2%/96.2% and 89.9%/86.9%, respectively. RFS was predicted by the radiotherapy (RT) field, with focal RT having the worst outcome, whereas chemotherapy usage had no impact on survival. Among patients who received chemotherapy, response to chemotherapy did not predict survival outcomes. In M0 patients, primary basal ganglia tumors predicted a worse RFS. In patients with bifocal tumors, an extended field RT was associated with better outcomes. In multivariable analysis, only RT fields were associated with RFS. In relapsed patients, salvage rates were high at 85.7%. Additionally, patients who received salvage RT had a better outcome (91.6% vs. 66.7%).
Survival outcomes of patients with germinoma were excellent. Thus, the focus of treatment for intracranial germinoma should be on survivorship. Further studies are warranted to find the optimal intensity and volume of radiation, including the role of chemotherapy in the survival of patients with intracranial germinomas, considering age, primary tumor location, and extent of disease.
本项多中心研究旨在报告在亚洲选定中心的颅内生殖细胞瘤患者的临床表现和治疗策略，包括失败模式、风险因素和结局。
对来自四个国家的八家医疗机构在 1995 年至 2015 年期间治疗的这些患者进行回顾性数据收集和分析。
共分析了 418 例患者，中位随访时间为 8.9 年；79.9%的患者为 M0，87.6%的患者β-人绒毛膜促性腺激素值<50mIU/ml。5/10 年总生存率（OS）和无复发生存率（RFS）分别为 97.2%/96.2%和 89.9%/86.9%。RFS 由放疗（RT）野预测，局灶性 RT 结局最差，而化疗的使用对生存无影响。在接受化疗的患者中，化疗反应并不能预测生存结局。在 M0 患者中，原发基底节肿瘤预测 RFS 较差。在双灶肿瘤患者中，扩展野 RT 与更好的结局相关。多变量分析显示，仅 RT 野与 RFS 相关。在复发性患者中，挽救率高达 85.7%。此外，接受挽救性 RT 的患者结局更好（91.6%比 66.7%）。
生殖细胞瘤患者的生存结局极好。因此，颅内生殖细胞瘤的治疗重点应放在生存上。鉴于年龄、原发肿瘤位置和疾病程度，需要进一步研究以确定最佳的放疗强度和体积，包括化疗在颅内生殖细胞瘤患者生存中的作用。
