Cancer Res Treat.  2020 Oct;52(4):1050-1058. 10.4143/crt.2020.437.

Comparison between Craniospinal Irradiation and Limited-Field Radiation in Patients with Non-metastatic Bifocal Germinoma

• Li B
• Lv W
• Li C
• Yang J
• Chen J
• Feng J
• Chen L
• Ma Z
• Li Y
• Wang J
• Liu Y
• Li Y
• Liu S
• Luo S
• Qiu X

• KMID: 2507932
• DOI: http://doi.org/10.4143/crt.2020.437

Abstract

Purpose
Whether craniospinal irradiation (CSI) could be replaced by limited-field radiation in non-metastatic bifocal germinoma remains controversial. We addressed the issue based on the data from our series and the literature.
Methods
Data from 49 patients diagnosed with non-metastatic bifocal germinoma at our hospital during the last 10 years were collected. The Pediatric Quality of Life Inventory 4.0 was used to evaluate health-related quality of life (HRQOL). Additionally, 81 patients identified from the literature were also analyzed independently.
Results
In our cohort, 34 patients had tumors in the sellar/suprasellar (S/SS) plus pineal gland (PG) regions and 15 in the S/SS plus basal ganglia/thalamus (BG/T) regions. The median follow-up period was 52 months (range, 10 to 134 months). Our survival analysis showed that patients treated with CSI (n=12) or whole-brain radiotherapy (WBRT; n=34) had comparable disease-free survival (DFS; p=0.540), but better DFS than those treated with focal radiotherapy (FR; n=3, p=0.016). All 81 patients from the literature had tumors in the S/SS+PG regions. Relapses were documented in 4/45 patients treated with FR, 2/17 treated with whole-ventricle irradiation, 0/4 treated with WBRT, and 1/15 treated with CSI. Survival analysis did not reveal DFS differences between the types of radiation field (p=0.785). HRQOL analysis (n=44) in our cohort found that, compared with S/SS+PG germinoma, patients with BG/T involvement had significantly lower scores in social and school domains. However, HRQOL difference between patients treated with CSI and those not treated with CSI was not significant.
Conclusion
In patients with non-metastatic bifocal germinoma, it is rational that CSI could be replaced by limited-field radiation. HRQOL in patients with BG/T involvement was poorer.

Keyword

Germinoma; Bifocal germinoma; Radiotherapy; Quality of life

Figure

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  Fig. 1. Images of an 18-year-old girl who presented with right hemiparesis and adipsic diabetes insipitus. β-Human chorionic gonadotropin in the serum and cerebrospinal fluid was 39.4 IU/L and 77.2 IU/L, respectively. Radiological examinations revealed lesions located in the sellar and left thalamus area (tumors were indicated by the arrows). The first row shows axial and sagittal graphics on contrast-enhanced magnetic resonance image. Pituitary stalk enhancement and a left thalamus lesion with enhancement can be seen. The second row shows images on plain computed tomography scan. Lesions showed slightly higher intensity compared to the surrounding normal tissues. She was diagnosed as bifocal germinoma and chemoradiotherapy was applied. The third row shows the complete remission of the lesions after treatment.

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  Fig. 2. Comparison of disease-free survival between patients undergoing focal radiotherapy (FR), whole-brain radiotherapy (WBRT), and craniospinal irradiation (CSI) (our cohort). Patients treated with CSI (n=12) or WBRT (n=34) had comparable disease-free survival (p=0.54), but better disease-free survival than those treated with FR (n=3, p=0.016).

• 

  Fig. 3. Images of a 19-year-old boy who presented with adipsic diabetes insipitus only. β-Human chorionic gonadotropin (β-HCG) in the serum and cerebrospinal fluid was 22.4 IU/L and 41.9 IU/L, respectively. (A, B) Radiological examinations revealed pituitary stalk enhancement and left thalamus lesion with enhancement (tumors were indicated by the arrows). Then, four cycles of chemotherapy and focal radiotherapy were applied. (C, D) Twenty months later, enhanced lesion with cyst was identified in the left thalamus area (within the initial radiation field) (tumors were indicated by the arrows). β-HCG in the serum and cerebrospinal fluid was 716 IU/L and 442 IU/L, respectively. Then, salvage chemoradiotherapy was applied.

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  Fig. 4. Comparison of disease-free survival between patients undergoing focal radiotherapy (FR), whole-ventricle irradiation (WVI), whole-brain radiotherapy (WBRT), and craniospinal irradiation (CSI) (literature cohort). Survival analysis did not reveal disease-free survival differences between the types of radiation field (p=0.79).

Reference

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