Treatment and outcomes of UK and German patients with relapsed intracranial germ cell tumors following uniform first-line therapy
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Authors
Bailey, S
Heinemann, K
Mann, J
Göbel, UK
Saran, F
Hale, JP
Calaminus, G
Nicholson, JC
Publication Date
2017-08-01Journal Title
International Journal of Cancer
ISSN
0020-7136
Publisher
Wiley
Volume
141
Issue
3
Pages
621-635
Language
English
Type
Article
This Version
AM
Metadata
Show full item recordCitation
Murray, M., Bailey, S., Heinemann, K., Mann, J., Göbel, U., Saran, F., Hale, J., et al. (2017). Treatment and outcomes of UK and German patients with relapsed intracranial germ cell tumors following uniform first-line therapy. International Journal of Cancer, 141 (3), 621-635. https://doi.org/10.1002/ijc.30755
Abstract
We aimed to retrospectively assess treatments/outcomes, including the value of high-dose-chemotherapy and autologous-stem-cell-rescue (HDC + AuSCR) and re-irradiation, in a large, European patient-cohort with relapsed intracranial germ-cell-tumors (GCTs) receiving uniform first-line therapy, including radiotherapy as standard-of-care. Fifty-eight UK/German patients (48 male/10 female) with relapsed intracranial-GCTs [13 germinoma/45 non-germinomatous GCT (NGGCT)] treated 1996-2010 as per the SIOP-CNS-GCT-96 protocol were evaluated. For germinoma, six patients relapsed with germinoma and five with NGGCT (one palliative, one teratoma patient excluded). Five-year overall-survival (OS) for the whole-group (n = 11) was 55%. Four of six germinoma relapses and two of five relapsing with NGGCT were salvaged; patients were salvaged with either standard-dose-chemotherapy (SDC) and re-irradiation or HDC + AuSCR with/without re-irradiation. Of 45 relapsed NGGCT patients, 13 were excluded (three non-protocol adherence, five teratoma, five palliation). Five-year OS for the remaining 32 relapsed malignant NGGCT patients treated with curative intent was 9% (95%CI: 2-26%). By treatment received, 5-year OS for the 10 patients receiving SDC and 22 patients treated with intention for HDC + AuSCR was 0% (0-0%) and 14% (3-36%), respectively. The three relapsed NGGCT survivors had raised HCG markers alone; two received additional irradiation. Patients with relapsed germinoma had better 5-year OS than those with relapsed NGGCT (55 vs. 9%; p = 0.007). Patients with relapsed germinoma were salvaged both with SDC and re-irradiation or HDC + AuSCR with/without re-irradiation; both represent valid treatment options. Outcomes for malignant relapse following initial diagnosis of NGGCT were exceptionally poor; the few survivors received thiotepa-based HDC + AuSCR, which is a treatment option at first malignant relapse for such patients, with further surgery/irradiation where feasible.
Keywords
germ cell tumor, high-dose chemotherapy, intracranial, non-germinoma, re-irradiation, relapse
Identifiers
External DOI: https://doi.org/10.1002/ijc.30755
This record's URL: https://www.repository.cam.ac.uk/handle/1810/265623
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