The role of neoadjuvant chemotherapy in the management of metastatic central nervous system germinoma: A meta-analysis.

Autor: Abu-Arja MH; Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas, USA., Shatara MS; Division of Hematology and Oncology, St. Louis Children's Hospital, Washington University, School of Medicine in St. Louis, Washington University, St. Louis, Missouri, USA., Okcu MF; Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas, USA., McGovern SL; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Su JM; Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas, USA., Abdelbaki MS; Division of Hematology and Oncology, St. Louis Children's Hospital, Washington University, School of Medicine in St. Louis, Washington University, St. Louis, Missouri, USA.
Jazyk: angličtina
Zdroj: Pediatric blood & cancer [Pediatr Blood Cancer] 2023 Oct; Vol. 70 (10), pp. e30601. Date of Electronic Publication: 2023 Jul 27.
DOI: 10.1002/pbc.30601
Abstrakt: Background: The role of neoadjuvant chemotherapy in treating patients with metastatic central nervous system (CNS) germinoma is controversial.
Methods: We compared the relapse-free survival (RFS) of different treatment modalities by performing a meta-analysis using published data. We summarized all data using standard descriptive statistics. We used the Kaplan-Meier method to estimate RFS and their corresponding 95% confidence intervals (CIs). We used the log-rank test for the comparison of survival functions.
Results: We identified 97 patients with a median age at presentation of 15 years (range: 7-38). Sites of metastasis were cerebrospinal fluid (CSF) disease only (n = 12), brain parenchyma (n = 18), spinal cord (n = 9), ventricular and CSF (n = 10), ventricular only (n = 31), and other (n = 17). The 3-year RFS among patients who received any form of radiotherapy was 89% (95% CI: 83-96) compared with 0% for patients who received a chemotherapy-only regimen (p = .001). Five-year RFS among patients who received craniospinal irradiation (CSI) was 92% (95% CI: 84-100) compared with 76.4% (95% CI: 63-90) in the non-CSI group (with or without neoadjuvant chemotherapy) (p = .014). Five-year RFS of patients who received CSI less than 24 Gy with neoadjuvant chemotherapy was 100% compared with 92% (95% CI: 83-100) CSI dose greater than or equal to 24 Gy alone (p = .3).
Conclusions: Our analysis does not support avoiding spinal irradiation among patients with radiographic metastatic CNS germinoma. Future studies are needed to confirm whether neoadjuvant chemotherapy will allow a reduction of irradiation dose without compromising survival.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE
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