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Treatment and outcomes of UK and German patients with relapsed intracranial germ cell tumors following uniform first-line therapy.

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Date
2017-08
ICR Author
Marsden,
Author
Murray, MJ
Bailey, S
Heinemann, K
Mann, J
Göbel, UK
Saran, F
Hale, JP
Calaminus, G
Nicholson, JC
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Type
Journal Article
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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.
URI
https://repository.icr.ac.uk/handle/internal/1092
DOI
https://doi.org/10.1002/ijc.30755
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Subject
Humans
Neoplasms, Germ Cell and Embryonal
Germinoma
Brain Neoplasms
Neoplasm Recurrence, Local
Antineoplastic Combined Chemotherapy Protocols
Neoplasm Staging
Prognosis
Combined Modality Therapy
Survival Rate
Retrospective Studies
Follow-Up Studies
Adolescent
Adult
Child
Child, Preschool
Infant
Germany
Female
Male
Young Adult
United Kingdom
Language
eng
Date accepted
2017-04-06
License start date
2017-08
Citation
International journal of cancer, 2017, 141 (3), pp. 621 - 635

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