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Late recurrence and salvage therapy of CNS germinomas
Authors:Kamoshima Yuuta  Sawamura Yutaka  Ikeda Jun  Shirato Hiroki  Aoyama Hidefumi
Institution:(1) Department of Neurosurgery, Hokkaido University Hospital, North-15, West-7, Kita-ku, Sapporo 060-8638, Japan;(2) Department of Radiology, Hokkaido University Hospital, Sapporo, Japan
Abstract:Central nervous system (CNS) germinoma is a curable tumor and its recurrence rate after initial therapy may be approximately 10% or higher. This study elucidates the time-course of recurrence and results of salvage therapy. Twenty-five patients with recurrent germinoma treated at Hokkaido University Hospital were retrospectively reviewed. The median age at initial treatment was 12 years (range: 8–37). All patients had been tumor-free for at least 6 months after the initial treatment. The median follow-up period was 134 months (range: 44–338). The median age at first recurrence was 18 years and the median time to the first recurrence was 50 months. Among the patients, 9 (36%) had the first recurrence at 60 months or later. The latest recurrence in a patient occurred 230 months after the initial treatment. The results of salvage therapy were estimated in all 25 patients. Seventeen patients (68%) were salvaged and were tumor-free at the final observation. The remaining 8 patients died of disease. At first recurrence, 11 patients were treated using radiation therapy with or without surgery and 7 out of the 11 patients died due to the recurrent tumor. On the other hand, 13 patients who received salvage chemotherapy and radiotherapy were tumor-free at the last follow-up. In conclusion, late recurrence is not a rare event in patients with CNS germinoma. To identify a true cure rate of this disease, a 10-year or longer observation period may be required. As a salvage therapy, platinum-based chemotherapy followed by wide-field low-dose radiation therapy appears to be effective.
Keywords:Central nervous system  Germinoma  Intracranial  Recurrence  Salvage therapy
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