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dc.contributor.authorMurray, Matthewen
dc.date.accessioned2018-01-25T16:22:25Z
dc.date.available2018-01-25T16:22:25Z
dc.date.issued2017-11-29en
dc.identifier.issn1522-8517
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/271127
dc.description.abstractBackground. Following promising results to increase survival and reduce treatment burden in intracranial non-germinomatous germ-cell-tumors (NGGCT), we conducted a European study using dose-intense chemotherapy followed by risk-adapted radiotherapy. Methods. All patients received four courses of Cisplatin/Etoposide/Ifosfamide. Non-metastatic patients then received focal radiotherapy only (54Gy); metastatic patients received 30Gy craniospinal radiotherapy with 24Gy boost to primary tumor and macroscopic metastatic sites. Results. Patients with localized malignant NGGCT (n=116) demonstrated five-year progression-free-survival (PFS) and overall-survival (OS) of 0.72±0.04 and 0.82±0.04, respectively. Primary tumor sites were: 67 pineal, 35 suprasellar, five bifocal, nine others. One patient died post-surgery in clinical remission; three patients progressed during treatment and 27 (23%) relapsed afterwards. Fourteen were local, six combined and seven distant relapses (outside radiation field). Seventeen of the 27 relapsed patients died of disease. Patients with metastatic disease (n=33) demonstrated five-year PFS and OS of 0.68±0.09 and 0.75±0.08, respectively; one patient died following progression on treatment and nine (27%) relapsed afterwards (five local, one combined, three distant). Only one metastatic patient with recurrence was salvaged. Multivariate analysis identified diagnostic alpha-fetoprotein level (serum and/or cerebrospinal fluid) (>1000ng/ml, 19/149 patients, of whom 11 relapsed; p<0.0003) and residual disease following treatment, including after second–look surgery (n=52/145 evaluable patients, 26 relapsed; p=0.0002), as significant prognostic indicators in this cohort. Conclusion. In localized malignant NGGCT craniospinal radiotherapy could be avoided without increased relapses outside the radiotherapy field. Chemotherapy and craniospinal radiotherapy remains the gold standard for metastatic disease.
dc.description.sponsorshipThe work was supported in part by Deutsche Krebshilfe e. V., Bonn, Germany and Elisabeth Dreves Stiftung, Germany.
dc.publisherOxford University Press
dc.subjectchemotherapyen
dc.subjectintracranial non-germinomaen
dc.subjectradiotherapyen
dc.subjectrelapseen
dc.subjecttoxicityen
dc.titleOutcome of patients with intracranial non-germinomatous germ cell tumors – lessons from the SIOP-CNS-GCT-96 trial.en
dc.typeArticle
prism.endingPage1672
prism.issueIdentifier12en
prism.publicationDate2017en
prism.publicationNameNeuro-Oncologyen
prism.startingPage1661
prism.volume19en
dc.identifier.doi10.17863/CAM.11435
dcterms.dateAccepted2017-06-28en
rioxxterms.versionofrecord10.1093/neuonc/nox122en
rioxxterms.versionAM*
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2017-11-29en
dc.contributor.orcidMurray, Matthew [0000-0002-4480-1147]
dc.identifier.eissn1523-5866
rioxxterms.typeJournal Article/Reviewen
cam.issuedOnline2017-07-05en
datacite.issupplementedby.doi10.1093/neuonc/nox122en
rioxxterms.freetoread.startdate2018-07-05


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