Treatment of Recurrent Childhood CNS Germ Cell Tumors
The most common type of relapse is local recurrence at the primary tumor site, but 30% of relapses are outside the primary site and/or combined with leptomeningeal spread. The outcome for patients with relapse, especially those with nongerminomatous germ cell tumors (NGGCTs), remains poor.
Treatment Options for Recurrent Childhood Central Nervous System (CNS) Germ Cell Tumors (GCTs)
Treatment options for recurrent childhood CNS GCTs include the following:
- Focal or craniospinal radiation therapy.
- Chemotherapy followed by radiation therapy.
- High-dose chemotherapy with stem cell rescue.
Patients with germinomas that were treated initially with chemotherapy only can benefit from chemotherapy followed by radiation therapy.[1,2] Re-irradiation after chemotherapy at recurrence has been utilized.[2,3]
For pure germinoma patients who previously received radiation therapy, myeloablative chemotherapy with stem cell rescue has been used.[4,5] High-dose chemotherapy and autologous stem cell rescue may also have curative potential for some patients with relapsed systemic NGGCTs.[4-7]
Enrollment on clinical trials should be considered for all patients with recurrent disease. Information about ongoing clinical trials is available from the NCI Web site.
- Merchant TE, Sherwood SH, Mulhern RK, et al.: CNS germinoma: disease control and long-term functional outcome for 12 children treated with craniospinal irradiation. Int J Radiat Oncol Biol Phys 46 (5): 1171-6, 2000. [PUBMED Abstract]
- Sawamura Y, Ikeda JL, Tada M, et al.: Salvage therapy for recurrent germinomas in the central nervous system. Br J Neurosurg 13 (4): 376-81, 1999. [PUBMED Abstract]
- Hu YW, Huang PI, Wong TT, et al.: Salvage treatment for recurrent intracranial germinoma after reduced-volume radiotherapy: a single-institution experience and review of the literature. Int J Radiat Oncol Biol Phys 84 (3): 639-47, 2012. [PUBMED Abstract]
- Siegert W, Beyer J, Strohscheer I, et al.: High-dose treatment with carboplatin, etoposide, and ifosfamide followed by autologous stem-cell transplantation in relapsed or refractory germ cell cancer: a phase I/II study. The German Testicular Cancer Cooperative Study Group. J Clin Oncol 12 (6): 1223-31, 1994. [PUBMED Abstract]
- Modak S, Gardner S, Dunkel IJ, et al.: Thiotepa-based high-dose chemotherapy with autologous stem-cell rescue in patients with recurrent or progressive CNS germ cell tumors. J Clin Oncol 22 (10): 1934-43, 2004. [PUBMED Abstract]
- Beyer J, Kramar A, Mandanas R, et al.: High-dose chemotherapy as salvage treatment in germ cell tumors: a multivariate analysis of prognostic variables. J Clin Oncol 14 (10): 2638-45, 1996. [PUBMED Abstract]
- Motzer RJ, Mazumdar M, Bosl GJ, et al.: High-dose carboplatin, etoposide, and cyclophosphamide for patients with refractory germ cell tumors: treatment results and prognostic factors for survival and toxicity. J Clin Oncol 14 (4): 1098-105, 1996. [PUBMED Abstract]