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OUTCOME OF CHILDREN AND ADOLESCENTS WITH INTRACRANIAL GERMINOMA TREATED WITH CHEMOTHERAPY AND REDUCED RADIATION: A BRAZILIAN CONSORTIUM.
Introduction, Objectives, Methods, Results, and Conclusion.
Introduction: Primary central nervous system (CNS) germ cell tumors (GCT) are rare tumors being classified according to their histological components and tumor markers (TM) as Germinomas and Non-Germinomatous germ cell tumors (NGGCT). The aim of the present study is to evaluate the outcome of Germinoma patients treated according a Brazilian CNSGCT consortium protocol. Methods: Since 2013, 57 patients with histologic and/or TM consistent with CNSGCT were diagnosed, 43 of them were Germinoma with/without HCGβ levels ≤200mIU/ml, five between 100-200mIU/ml. The treatment plan consists of four cycles of carboplatin/etoposide followed by 18Gy ventricular field irradiation and primary site(s) boost up to 30Gy and 24Gy craniospinal for disseminated disease. Results: Mean age 13,2 years (4.7-25,5y), 29 males. Diagnosis was made by TM (n=6), surgery (n=27), both (n=10). Two bifocal cases, with negative TM were treated as germinoma. Primary tumor location was pineal (n=18), suprasellar (n=14), bifocal (n=10) and basal ganglia/thalamus (n=1). Fourteen had ventricular/spinal spread. Second-look surgery occurred in two patients (teratoma). Thirty-six patients achieved complete response (CR) after chemotherapy, seven showed residual teratoma/scar. Radiotherapy was performed as described, except one. Toxicity was mostly grade 3/4 neutropenia/thrombocytopenia during chemotherapy. At a median follow-up of 40 months, event-free and overall survival was 100%. Conclusion: The treatment is tolerable and VFI dose reduction to 18Gy preserve the efficacy with excellent outcome, even in the cases of HCG levels between 100-200mlU/ml.
Keywords (separated by comma on a single line)
CNS germ cell tumors, intracranial germinoma, pediatric germ cell tumors
NATALIA DASSI, NASJLA SABA SILVA, BRUNA MANÇANO, DANIELA BARBOSA ALMEIDA, SERGIO CAVALHEIRO, PATRICIA A DASTOLI, MARIA TERESA S ALVES, FREDERICO A SILVA, SIDNEI EPELMAN, SIMONE AGUIAR, JONATHAN L FINLAY, ANDREA MARIA CAPPELLANO