Salvage treatment for recurrent intracranial germinoma after reduced-volume radiotherapy: A single-institution experience and review of the literature

Yu Wen Hu, Pin I. Huang, Tai-Tong Wong, Donald Ming Tak Ho, Kai Ping Chang, Wan Yuo Guo, Feng Chi Chang, Cheng Yin Shiau, Muh Lii Liang, Yi Yen Lee, Hsin Hung Chen, Sang Hue Yen, Yi Wei Chen

研究成果: 雜誌貢獻文章

11 引文 (Scopus)

摘要

Purpose: Intracranial germinomas (IGs) are highly curable with radiotherapy (RT). However, recurrence still occurs, especially when limited-field RT is applied, and the optimal salvage therapy remains controversial. Methods and Materials: Between January 1989 and December 2010, 14 patients with clinically or pathologically diagnosed recurrent IGs after RT were reviewed at our institution. Of these, 11 received focal-field RT, and the other 3 received whole-brain irradiation, whole-ventricle irradiation, and Gamma Knife radiosurgery as the respective first course of RT. In addition, we identified from the literature 88 patients with recurrent IGs after reduced-volume RT, in whom the details of salvage therapy were recorded. Results: The median time to recurrence was 30.3 months (range, 3.8-134.9 months). One patient did not receive further treatment and was lost during follow-up. Of the patients, 7 underwent salvage with craniospinal irradiation (CSI) plus chemotherapy (CT), 4 with CSI alone, 1 with whole-brain irradiation plus CT, and 1 with Gamma Knife radiosurgery. The median follow-up time was 105.1 months (range, 24.2-180.9 months). Three patients died without evidence of disease progression: two from second malignancies and one from unknown cause. The others remained disease free. The 3-year survival rate after recurrence was 83.3%. A total of 102 patients from our study and the literature review were analyzed to determine the factors affecting prognosis and outcomes. After recurrence, the 5-year survival rates were 71% and 92.9% for all patients and for those receiving salvage CSI, respectively. Univariate analysis showed that initial RT volume, initial RT dose, initial CT, and salvage RT type were significant prognostic predictors of survival. On multivariable analysis, salvage CSI was the most significant factor (p = 0.03). Conclusions: Protracted follow-up is recommended because late recurrence is not uncommon. CSI with or without CT is an effective salvage treatment for recurrence after reduced-volume RT.

原文英語
頁(從 - 到)639-647
頁數9
期刊International Journal of Radiation Oncology Biology Physics
84
發行號3
DOIs
出版狀態已發佈 - 十一月 1 2012
對外發佈Yes

指紋

Germinoma
Salvage Therapy
radiation therapy
Radiotherapy
Craniospinal Irradiation
irradiation
chemotherapy
Recurrence
Drug Therapy
Radiosurgery
brain
therapy
Survival Rate
Second Primary Neoplasms
prognosis
Brain
progressions
Disease Progression

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

引用此文

Salvage treatment for recurrent intracranial germinoma after reduced-volume radiotherapy : A single-institution experience and review of the literature. / Hu, Yu Wen; Huang, Pin I.; Wong, Tai-Tong; Ho, Donald Ming Tak; Chang, Kai Ping; Guo, Wan Yuo; Chang, Feng Chi; Shiau, Cheng Yin; Liang, Muh Lii; Lee, Yi Yen; Chen, Hsin Hung; Yen, Sang Hue; Chen, Yi Wei.

於: International Journal of Radiation Oncology Biology Physics, 卷 84, 編號 3, 01.11.2012, p. 639-647.

研究成果: 雜誌貢獻文章

Hu, Yu Wen ; Huang, Pin I. ; Wong, Tai-Tong ; Ho, Donald Ming Tak ; Chang, Kai Ping ; Guo, Wan Yuo ; Chang, Feng Chi ; Shiau, Cheng Yin ; Liang, Muh Lii ; Lee, Yi Yen ; Chen, Hsin Hung ; Yen, Sang Hue ; Chen, Yi Wei. / Salvage treatment for recurrent intracranial germinoma after reduced-volume radiotherapy : A single-institution experience and review of the literature. 於: International Journal of Radiation Oncology Biology Physics. 2012 ; 卷 84, 編號 3. 頁 639-647.
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abstract = "Purpose: Intracranial germinomas (IGs) are highly curable with radiotherapy (RT). However, recurrence still occurs, especially when limited-field RT is applied, and the optimal salvage therapy remains controversial. Methods and Materials: Between January 1989 and December 2010, 14 patients with clinically or pathologically diagnosed recurrent IGs after RT were reviewed at our institution. Of these, 11 received focal-field RT, and the other 3 received whole-brain irradiation, whole-ventricle irradiation, and Gamma Knife radiosurgery as the respective first course of RT. In addition, we identified from the literature 88 patients with recurrent IGs after reduced-volume RT, in whom the details of salvage therapy were recorded. Results: The median time to recurrence was 30.3 months (range, 3.8-134.9 months). One patient did not receive further treatment and was lost during follow-up. Of the patients, 7 underwent salvage with craniospinal irradiation (CSI) plus chemotherapy (CT), 4 with CSI alone, 1 with whole-brain irradiation plus CT, and 1 with Gamma Knife radiosurgery. The median follow-up time was 105.1 months (range, 24.2-180.9 months). Three patients died without evidence of disease progression: two from second malignancies and one from unknown cause. The others remained disease free. The 3-year survival rate after recurrence was 83.3{\%}. A total of 102 patients from our study and the literature review were analyzed to determine the factors affecting prognosis and outcomes. After recurrence, the 5-year survival rates were 71{\%} and 92.9{\%} for all patients and for those receiving salvage CSI, respectively. Univariate analysis showed that initial RT volume, initial RT dose, initial CT, and salvage RT type were significant prognostic predictors of survival. On multivariable analysis, salvage CSI was the most significant factor (p = 0.03). Conclusions: Protracted follow-up is recommended because late recurrence is not uncommon. CSI with or without CT is an effective salvage treatment for recurrence after reduced-volume RT.",
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author = "Hu, {Yu Wen} and Huang, {Pin I.} and Tai-Tong Wong and Ho, {Donald Ming Tak} and Chang, {Kai Ping} and Guo, {Wan Yuo} and Chang, {Feng Chi} and Shiau, {Cheng Yin} and Liang, {Muh Lii} and Lee, {Yi Yen} and Chen, {Hsin Hung} and Yen, {Sang Hue} and Chen, {Yi Wei}",
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T2 - A single-institution experience and review of the literature

AU - Hu, Yu Wen

AU - Huang, Pin I.

AU - Wong, Tai-Tong

AU - Ho, Donald Ming Tak

AU - Chang, Kai Ping

AU - Guo, Wan Yuo

AU - Chang, Feng Chi

AU - Shiau, Cheng Yin

AU - Liang, Muh Lii

AU - Lee, Yi Yen

AU - Chen, Hsin Hung

AU - Yen, Sang Hue

AU - Chen, Yi Wei

PY - 2012/11/1

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N2 - Purpose: Intracranial germinomas (IGs) are highly curable with radiotherapy (RT). However, recurrence still occurs, especially when limited-field RT is applied, and the optimal salvage therapy remains controversial. Methods and Materials: Between January 1989 and December 2010, 14 patients with clinically or pathologically diagnosed recurrent IGs after RT were reviewed at our institution. Of these, 11 received focal-field RT, and the other 3 received whole-brain irradiation, whole-ventricle irradiation, and Gamma Knife radiosurgery as the respective first course of RT. In addition, we identified from the literature 88 patients with recurrent IGs after reduced-volume RT, in whom the details of salvage therapy were recorded. Results: The median time to recurrence was 30.3 months (range, 3.8-134.9 months). One patient did not receive further treatment and was lost during follow-up. Of the patients, 7 underwent salvage with craniospinal irradiation (CSI) plus chemotherapy (CT), 4 with CSI alone, 1 with whole-brain irradiation plus CT, and 1 with Gamma Knife radiosurgery. The median follow-up time was 105.1 months (range, 24.2-180.9 months). Three patients died without evidence of disease progression: two from second malignancies and one from unknown cause. The others remained disease free. The 3-year survival rate after recurrence was 83.3%. A total of 102 patients from our study and the literature review were analyzed to determine the factors affecting prognosis and outcomes. After recurrence, the 5-year survival rates were 71% and 92.9% for all patients and for those receiving salvage CSI, respectively. Univariate analysis showed that initial RT volume, initial RT dose, initial CT, and salvage RT type were significant prognostic predictors of survival. On multivariable analysis, salvage CSI was the most significant factor (p = 0.03). Conclusions: Protracted follow-up is recommended because late recurrence is not uncommon. CSI with or without CT is an effective salvage treatment for recurrence after reduced-volume RT.

AB - Purpose: Intracranial germinomas (IGs) are highly curable with radiotherapy (RT). However, recurrence still occurs, especially when limited-field RT is applied, and the optimal salvage therapy remains controversial. Methods and Materials: Between January 1989 and December 2010, 14 patients with clinically or pathologically diagnosed recurrent IGs after RT were reviewed at our institution. Of these, 11 received focal-field RT, and the other 3 received whole-brain irradiation, whole-ventricle irradiation, and Gamma Knife radiosurgery as the respective first course of RT. In addition, we identified from the literature 88 patients with recurrent IGs after reduced-volume RT, in whom the details of salvage therapy were recorded. Results: The median time to recurrence was 30.3 months (range, 3.8-134.9 months). One patient did not receive further treatment and was lost during follow-up. Of the patients, 7 underwent salvage with craniospinal irradiation (CSI) plus chemotherapy (CT), 4 with CSI alone, 1 with whole-brain irradiation plus CT, and 1 with Gamma Knife radiosurgery. The median follow-up time was 105.1 months (range, 24.2-180.9 months). Three patients died without evidence of disease progression: two from second malignancies and one from unknown cause. The others remained disease free. The 3-year survival rate after recurrence was 83.3%. A total of 102 patients from our study and the literature review were analyzed to determine the factors affecting prognosis and outcomes. After recurrence, the 5-year survival rates were 71% and 92.9% for all patients and for those receiving salvage CSI, respectively. Univariate analysis showed that initial RT volume, initial RT dose, initial CT, and salvage RT type were significant prognostic predictors of survival. On multivariable analysis, salvage CSI was the most significant factor (p = 0.03). Conclusions: Protracted follow-up is recommended because late recurrence is not uncommon. CSI with or without CT is an effective salvage treatment for recurrence after reduced-volume RT.

KW - Craniospinal irradiation

KW - Germinoma

KW - Radiotherapy

KW - Recurrence

KW - Salvage treatment

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