Abstract Background Response-adapted radiation therapy has been the treatment approach for germinoma after neoadjuvant chemotherapy. However, the presence of residual lesions at the end of chemotherapy did not demonstrate a negative impact on progression-free survival (PFS). While no malignant component was found generally in excised residuals, resection of residual tumors after chemotherapy did not also demonstrate a survival benefit. Aim To determine outcomes of germinoma patients who received chemotherapy and radiation therapy without primary tumor boost. Method This is a retrospective study analyzing the outcome of a cohort of paediatric germinoma patients treated with 4 cycles of carboplatin/ etoposide chemotherapy followed by cranial radiotherapy without primary tumor boost in a university hospital in Malaysia from January 2023 to December 2024. Result 5 patients (5 male; mean age 14.3years) were analysed. Median follow-up was 25months (range 17-26months). Four children had localized disease and tumor location was pituitary stalk (n = 1), pineal (n = 1), basal ganglia (n = 1) and bifocal (n = 1)while 1 child had intracranial metastatic disease at presentation. After chemotherapy, complete response was achieved in one patient who had pituitary stalk involvement, and 4 achieved partial response. All patients received radiotherapy to 23.4 Gy regardless of the chemotherapy response. Two patients with basal ganglia and cranial metastatic disease received whole brain irradiation . Whole ventricular irradiation was delivered to the other 3 patients. The 4 patients with partial response post-chemotherapy continued to demonstrate further reduction of tumor size after radiotherapy or during subsequent 3-monthly surveillance imaging. One patient showed a residual tumour during the last MRI. Event-free survival was 100% in this cohort. 1. 1. Foo JC, Yaman Bajin I, Marushchak O, McKeown T, Bouffet E, Tsang DS, Laperriere N, Dirks P, Drake J, Ertl-Wagner B, Bartels U. Time to dismiss boost? Outcomes of children with localized and metastatic germinoma. J Neurooncol. 2023 Apr;162(2):443-448. doi: 10.1007/s11060-023-04307-5. Epub 2023 Apr 11. PMID: 37039951. 2. 2. Bartels U, Onar-Thomas A, Patel SK, Shaw D, Fangusaro J, Dhall G, Souweidane M, Bhatia A, Embry L, Trask CL, Murphy ES, MacDonald S, Wu S, Boyett JM, Leary S, Fouladi M, Gajjar A, Khatua S. Phase II trial of response-based radiation therapy for patients with localized germinoma: a Children’s Oncology Group study. Neuro Oncol. 2022 Jun 1;24(6):974-983. doi: 10.1093/neuonc/noab270. PMID: 34850169; PMCID: PMC9159444. 3. 3. Calaminus G, Bison B, Faure-Conter C, Frappaz D, Peyrl A, Gerber N, Müller JE, Thankamma A, Mitra D, Cross J, Pietsch T, Smith C, Solem K, Devenney I, Garre ML, Brisse H, Zimmermann M, Kortmann RD, Alapetite C, Nicholson J (2020) 24Gy whole ventricular radiotherapy alone is sufficient for disease control in localised germinoma in CR after initial chemotherapy- early results of the SIOP CNS GCT II Study. Neuro Oncol. Dec 4;22(Suppl 3): iii343–4. doi: 10.1093/neuonc/noaa222.292.
Foo et al. (Tue,) studied this question.
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