gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Multi-institutional, prospective Phase II study for primary intracranial germ cell tumors

Meeting Abstract

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  • M. Matutani - Department of Neruo-Oncology, International Medical Center, Saitama Medical University, Saitama, Japan, and the Japanese CNS Germ Cell Tumor Study Group

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.14.06

DOI: 10.3205/12dgnc128, URN: urn:nbn:de:0183-12dgnc1284

Published: June 4, 2012

© 2012 Matutani.
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Outline

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Objective: After summarizing the 1st mult-institutional clinical study for intracranial germ cell tumors (1995–2003), we started a multi-institutional, prospective Phase II study for primary intracranial germ cell tumors.

Methods: In the first study, we evaluated 10 years OS and PFS of histology-verified 228 patients with the median follow-up period of 8.2 years. They were classified into 3 therapeutic groups; germinoma, intermediate prognosis group (IPG), and poor prognosis group (PPG). Patients with germinoma (n = 123) were treated by CARE (carboplatin 450 mg/sqm in day 1, etoposide 150 mg/sqm in days 1–3) followed by ventricular irradiation (24 Gy). Forty patients in the IPG were treated by CARE followed by local irradiation (50 Gy). They received additional chemotherapy for 5 times. Patients with the PPG (n = 27) were treated by ICE (IFOS 900 mg/sqm, cisplatin 20 mg/sqm, and etoposide 60 mg/sqm in days 1–5) and concurrent whole neuroaxis irradiation. They received additional chemotherapy for 5 times.

Results: The 10 years OS & PFS were 97.5% and 84.7% in germinoma patients, 89.3% and 81.5% IPG patients, and 58.8% and 62.7% in PPG patients, respectively. However, the protocol was not followed completely in some cases. In 36% of germinomas and 21% of HCG germinomas, the radiation volume was smaller than planned extended local field, and these patients showed high recurrent rate of 27%. In 59% of poor prognosis group, concurrent RT and CMT was not delivered with a fear of severe myelosuppresion, resulted in high rate of recurrence.

Conclusions: From the analysis of treatment failure in the 1st clinical study, we planed the 2nd multi-institutional, prospective Phase II study for primary intracranial germ cell tumors. The basic design of the study is to follow the protocol in the 1st study with stricter treatment plan and the objective is to evaluate the efficacy and safety of post-operative histology-oriented radiotherapy and chemotherapy proposed by the 1st study.