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Primary
chemotherapy for intracranial nongerminomatous germ cell tumors: results of the
second international CNS germ cell study group protocol
Kellie SJ, Boyce H, Dunkel IJ, Diez B, Rosenblum M, Brualdi L, Finlay JL
MB, BS, Oncology Unit, The Children's Hospital at Westmead,
Locked Bag 4001, Westmead, NSW 2145, Australia; e-mail: stewartk@chw.edu.au
Purpose. The optimum therapy for intracranial nongerminomatous
germ cell tumors (NGGCT) remains controversial.
The primary objective of this study was to determine whether intensive cisplatin
and cyclophosphamide-based combination chemotherapy was effective in patients
with intracranial NGGCT.
Patients
and Methods.
Twenty patients were enrolled, aged 5 to 41 years (median, 13 years).
Initial therapy included two courses of Regimen A (cisplatin, etoposide,
cyclophosphamide, and bleomycin).
Patients achieving a complete remission (CR) then received two courses of
Regimen B (carboplatin, etoposide, and bleomycin).
Those in CR after four courses of treatment received one additional course of
Regimen A and Regimen B, while those not in CR after four treatment courses
underwent second-look surgery and/or irradiation.
Results.
Sixteen of 17 patients assessable for response after two courses of treatment
achieved a CR or partial response (CR + partial response, 0.94; 95% CI, 0.73 to
1.0).
With a median follow-up of 6.3 years, 14 of 20 patients are alive without
disease; eight patients were without relapse or progression, of whom three
received local irradiation in first complete remission in violation of protocol,
and six patients were in durable second or third complete remission after
further chemotherapy and/or irradiation.
The 5-year overall survival and event-free survival were 0.75 (95% CI, 0.56 to
0.94) and 0.36 (95% CI, 0.13 to 0.59), respectively.
Conclusion.
Intensive chemotherapy was effective in one-third of patients in this
study.
Salvage therapy, including irradiation, was feasible in patients with recurrent
disease.
PMID: 14990640 [PubMed - in process]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14990640&dopt=Abstract
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