Phase II Trial of Pathology-based Tripartite Treatment Stratification for Patients with CNS Germ Cell Tumors: A Long-term Follow-up Study.

Autor:	Takami H; Department of Neurosurgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan., Matsutani M; Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan., Suzuki T; Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan., Takabatake K; Department of Neurosurgery, Saitama Medical University Hospital, Saitama, Japan., Fujimaki T; Department of Neurosurgery, Saitama Medical University Hospital, Saitama, Japan., Okamoto M; Department of Neurosurgery, Hokkaido University School of Medicine, Hokkaido, Japan., Yamaguchi S; Department of Neurosurgery, Hokkaido University School of Medicine, Hokkaido, Japan., Kanamori M; Department of Neurosurgery, Tohoku University Graduate School of Medicine, Miyagi, Japan., Matsuda K; Department of Neurosurgery, Faculty of Medicine, Yamagata University, Yamagata, Japan., Sonoda Y; Department of Neurosurgery, Faculty of Medicine, Yamagata University, Yamagata, Japan., Natsumeda M; Department of Neurosurgery, Niigata University, Niigata, Japan., Ichinose T; Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan., Nakada M; Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan., Muroi A; Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan., Ishikawa E; Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan., Takahashi M; Department of Neurosurgery and Neuro-oncology, National Cancer Center Hospital, Tokyo, Japan., Narita Y; Department of Neurosurgery and Neuro-oncology, National Cancer Center Hospital, Tokyo, Japan., Tanaka S; Department of Neurosurgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan., Saito N; Department of Neurosurgery, Faculty of Medicine, The University of Tokyo Hospital, Tokyo, Japan., Higuchi F; Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan., Shin M; Department of Neurosurgery, Teikyo University School of Medicine, Tokyo, Japan., Mineharu Y; Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan., Arakawa Y; Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan., Kagawa N; Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan., Kawabata S; Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Osaka, Japan., Wanibuchi M; Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Osaka, Japan., Takayasu T; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan., Yamasaki F; Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan., Fujii K; Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan., Ishida J; Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan., Date I; Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama, Japan., Miyake K; Department of Neurological Surgery, Kagawa University, Kagawa, Japan., Fujioka Y; Department of Neurosurgery, Kyushu University, Fukuoka, Japan., Kuga D; Department of Neurosurgery, Kyushu University, Fukuoka, Japan., Yamashita S; Department of Neurosurgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan., Takeshima H; Department of Neurosurgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan., Shinojima N; Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan., Mukasa A; Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan., Asai A; Department of Neurosurgery, Kansai Medical University Hospital, Osaka, Japan., Nishikawa R; Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan.
Jazyk:	angličtina
Zdroj:	Neuro-oncology [Neuro Oncol] 2024 Nov 02. Date of Electronic Publication: 2024 Nov 02.
DOI:	10.1093/neuonc/noae229
Abstrakt:	Background: A previous Phase II clinical trial, conducted from 1995 to 2003, evaluated CNS germ cell tumors (GCTs) using a three-group treatment stratification based on histopathology. The primary objective of the study was to assess the long-term efficacy of standardized treatment regimens, while the secondary objective focused on identifying associated long-term complications. Methods: Total 228 patients were classified into three groups for treatment: germinoma (n=161), intermediate prognosis (n=38), and poor prognosis (n=28), excluding one mature teratoma case. Treatment involved stratified chemotherapy regimens and varied radiation doses/coverage. Clinical data was retrospectively analyzed at a median follow-up of 18.5 years. Results: The treatment outcomes for germinoma, with or without syncytiotrophoblastic giant cell, were similar. The 10- and 20-year event-free survival rates for the germinoma, intermediate, and poor prognosis groups were 82/76/49% and 73/66/49%, respectively. Overall survival (OS) rates were 97/87/61% at 10 years and 92/70/53% at 20 years. Germinomas in the basal ganglia, treated without whole-brain radiation therapy (WBRT), frequently relapsed but were effectively managed with subsequent WBRT. Deaths in germinoma cases had varied causes, whereas deaths in the poor prognosis group were predominantly disease-related. Nineteen treatment-related complications were identified in 16 patients, with cumulative event rates of 1.9% at 10 years and 11.3% at 20 years. OS rates at 1 and 2 years post-relapse for tumors initially classified as germinoma, intermediate, and poor prognosis were 94/88/18% and 91/50/9%, respectively. Conclusions: Initial treatment intensity is crucial for managing non-germinomatous GCTs, while long-term follow-up for relapse and complications is imperative in germinomas. Irradiation extending beyond the immediate tumor site is essential for basal ganglia germinomas. Addressing relapse in non-germinomatous GCT remains a significant challenge. (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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