ESTRO 2024 - Abstract Book

S922

Clinical - CNS

ESTRO 2024

The 3 atypical primary disease sites were left optic nerve, periventricular and thalamic.

Patients were treated according to UK CCLG guidance. Localised germinomas received 4 cycles of chemotherapy (cycles 1 and 3 etoposide and carboplatin, cycles 2 and 4 etoposide and ifosfamide) followed by WVRT with or without boost. Metastatic germinomas received craniospinal irradiation (CSI) followed by boost to primary and metastatic sites. NGGCT received four cycles of cisplatin, etoposide and ifosfamide (PEI) followed by WVRT then boost to the primary site(s) for localised disease, and CSI then boosts to primary and metastatic sites for disseminated disease. One patient with NGGCT was treated with 4 cycles of PEI then focal radiotherapy, before updated CCLG guidance recommended adding WVRT. One patient with metastatic germinoma plus teratoma received 2 cycles of cisplatin and etoposide and NGGCT radiotherapy doses. One incompletely staged unifocal standard risk NGGCT after partial response to PEI had surgery, then local and metastatic progression, so received second line chemotherapy before CSI. All patients with pre-treatment AFP> 1000 ng/ml (n=5) and two patients with AFP value of <1000ng/ml (912 and 968) were treated with intensified chemotherapy. Three patients had relapsed at the time of last follow-up, all NGGCT (2/7 with high risk and 1/17 with standard risk disease). One with bifocal standard risk disease progressed with spinal metastases at 5.0 months and died despite attempted salvage with chemotherapy and CSI. One patient with unifocal high risk disease progressed locally at 3.9 months, was salvaged with gemcitabine, oxaliplatin and paclitaxel, surgery and CSI and was disease free at last follow up 13.2 months from end of first radiotherapy. One patient with metastatic high risk disease progressed at 0.9 months and died at 3.0 months despite salvage chemotherapy. All germinoma patients remained progression free at last follow up.

Ten patients developed acute grade 3 toxicities: 3 vomiting (2 CSI, 1 WVRT), and 7 lymphopenia (all received CSI). There were no acute toxicities above grade 3.

Conclusion:

Disease control for localised and metastatic intracranial germinoma was excellent. Outcomes in the NGGCT group were inferior, with early post treatment recurrences, especially in the high risk group. Among the patients with localised NGGCT, none progressed within the ventricular volume, suggesting a possible benefit of adding the WVRT field. Craniospinal proton radiotherapy was well tolerated with low rates of acute high grade toxicities. Further prospective randomised controlled trials are needed. In the NGGCT group, the focus should be to improve survival. This could include intensifying chemotherapy for a wider group, or spinal prophylaxis. In the germinoma group, treatment intensity might be de-escalated to reduced late effects.

Keywords: gct, intracranial, outcomes

References:

1) Calaminus G, Rolf Dieter Kortmann, Worch J, Nicholson JC, Alapetite C, Maria Luisa Garrè, et al. SIOP CNS GCT 96: final report of outcome of a prospective, multinational nonrandomized trial for children and adults with intracranial germinoma, comparing craniospinal irradiation alone with chemotherapy followed by focal primary site irradiation for patients with localized disease. Neuro-oncology. 2013 Mar 3;15(6):788 – 96.