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  • [Cancer Res Treat.] Long-Term Outcomes and Sequelae Analysis of Intracranial Germinoma: Need to Reduce the Extended-Field Radiotherapy Volume and Dose to Minimize Late Sequelae

    국립암센터, 서울의대 / 이주호, 왕규창*, 김일한*

  • 출처
    Cancer Res Treat.
  • 등재일
    2021 Oct
  • 저널이슈번호
    53(4):983-990. doi: 10.4143/crt.2020.1052. Epub 2021 Jan 13.
  • 내용

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    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 10 patients (5.3%) with a latency of 20 years (range, 4 to 26 years) 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: De-intensifying extended-field rather than involved-field or total scheme of RT 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.

     

     


    Affiliations

    Joo Ho Lee  1   2 , Keun-Yong Eom  3 , Ji Hoon Phi  4 , Chul-Kee Park  4 , Seung Ki Kim  4 , Byung-Kyu Cho  5 , Tae Min Kim  6 , Dae Seog Heo  6 , Kyung Taek Hong  7 , Jung Yoon Choi  7 , Hyoung Jin Kang  7 , Hee Young Shin  7 , Seung Hong Choi  8 , Soon Tae Lee  9 , Sung Hye Park  10 , Kyu-Chang Wang  11 , Il Han Kim  1
    1 Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
    2 Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea.
    3 Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
    4 Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
    5 Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea.
    6 Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
    7 Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
    8 Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
    9 Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
    10 Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
    11 Department of Neurosurgery, National Cancer Center, Goyang, Korea.

     

  • 키워드
    Germinoma; Radiation toxicity; Radiation-induced neoplasms; Radiotherapy.
  • 편집위원

    Intracranial germinoma에서 optimal RT field와 RT dose가 정립되지 않았는데, 재발 패턴 및 후기 합병증을 비교 분석하여, WBRT와 high dose of extended field RT가 후기 합병증을 높이고, IFRT시 periventricular recurrence 위험성을 고려하여, de-intensifying extended field RT를 제시한 흥미로운 연구입니다.

    2021-12-06 14:26:59

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