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Malignant
CNS germ cell tumors (GCTS): Interim analysis after 5 years of SIOP CNS GCT 96
G.
Calaminus, C. Alapetite, D. Frappaz, L. M. Garre, R. Kortmann, J. Nicholson, C.
Patte, U. Ricardi, F. Saran, U. Goebel
for
the SIOP CNS GCT Group; University Childrens Hospital, Duesseldorf, DE, Germany;
Institute Curie, Paris, DE, France; Centre Leon Bernard, Lyon, DE, France;
Gaslini Childrens Hospital, Genua, Italy; Med. Strahleninstitut der
Universitaet, Tuebingen, Germany; Addenbrooked Hospital, Cambridge, UK;
Institute Gustave Roussy, Paris, France; Ospedale Infantile Regina Margherita,
Turin, Italy; Royal Marsden Hospital, Sutton, UK; University Childrens Hospital,
Duesseldorf, Germany
Objective.
The study aims were to standardise diagnostics and treatment of GCTs; in
germinoma (G) to compare in a non randomized fashion 2 x CarboPEI + irradiation
(RT) with craniospinal RT (CSI) in localised disease; and in non-germinoma (NG),
to evaluate a strategy of preoperative chemo, if markers elevated and imaging
consistent, and RT taylored to extent of disease.
Patients.
Until 1/2001, 150 protocol patients (pts) with G, 109 pts with NG were
registered and evaluated as intend to treat.
Treatment
and Results. G: 122 pts were valued as non-metastatic and 28 as metastatic.
91 pts had CSI, 37 chemo+focal RT.
9 received chemo+CSI.
No info concerning RT was available in 13 pts.
142/150 pts are in CR: EFS in pts with chemo+focal RT is 0.89+0.05, EFS in pts
with CSI alone is 0.91+0.05 (median follow-up 32 months), 4 relapsed after CSI
and 4 after chemo+focal RT.
In pts with focal RT relapses tended to occur in the ventricular area.
NG: 86 pts were valued as non-metastatic and 23 as
metastatic.
56 pts received chemo+focal RT, 33 received chemo+CSI.
2 pts died after surgery and 5 children did not receive RT because of age (<5
yrs).
In 13 pts no info concerning RT was given.
82/109 pts are in CR.
25 relapses occured: 16 after focal RT and 9 after CSI.
Analyses show a prognostic impact of AFP value and residual disease after
irradiation on outcome.
EFS in pts with chemo+focal RT is 0.36+0.09, EFS in pts with chemo and CSI is
0.75+0.11 (median follow-up 28 months).
Conclusion.
The number of registered pts and participating countries in the international
study improved steadily over the years.
G: Chemo+RT is equal to CSI in local disease.
NG: Outcome of patients is satisfactory.
Treatment has to be further optimized in respect to the evaluated data and the
detected prognostic factors for outcome.
Supported
in part by Deutsche Krebshilfe.
© Copyright 2003
American Society of Clinical Oncology All rights
reserved worldwide
Source: http://www.asco.org/ac/1,1003,_12-002489-00_18-002003-00_19-00102662-00_29-00A,00.asp?cat=CNS+Tumors&parent=
Central+Nervous+System+Tumors&returnpid=2325&SubCat_ID=4
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