|
|
Bifocal Intracranial
germinoma (BIG): Is there a place for localized radiation?
M. M. Meshref, D. Frappaz, C. Alapetite, J. . Gentet, Y. Perel, M. C.
Baranzelli, P. Chastagner, C. Patte
Centre Leon Berard, Lyon, France; Institut Curie, PARIS, France;
Hopital de la timone, Marseille, France; Hopital des enfants, Bordeau, France;
Centre Oscar Lambret, Lille, France; CHU hopital d'enfants de Nancy, NANCY,
France; Institut Gustave Roussy, Villejuif., France
Background.
Bifocal tumours represent 7- 12 % of primary cerebral germ
cell tumours and are mostly germinomas.
The treatment of non metastatic germinomas includes either craniospinal
irradiation (CSI) or chemotherapy with focal RT.
BIG still represent a challenge.
Should they be treated as localized or metastatic disease?
This study aims to evaluate the outcome of treatment of BIG treated by
chemotherapy followed by localized radiation to tumour bed in non metastatic
disease.
Methods.
The data of 118 patients included from 1990-1999 in the
SFOP-TGM-TC 90-92 protocol for intracranial germ cell tumours were
reviewed.
The treatment of patients with germinomas (80 patients) included 2 cycles of
alternating carboplatine/Etoposide and Ifosfamide /Etoposide followed by focal
RT (40 Gy) delivered to initial target in localised diseases or CSI in
metastatic patients.
Results.
12/118 germ cell tumours had bifocal disease: 2/38 in the
secreting group, 10/80 in the non secreting germinoma group.
Two of these 10 were metastatic and were treated with chemotherapy followed by
CSI.
Thus 8 patients had localised BIG.
One was electively treated by chemotherapy followed by CSI.
Thus 7 received chemotherapy followed by focal RT with a 2 cm safety
margin.
With a mean follow-up of 108 months (76 to 144), only one patient suffered local
relapse (at 28 months) and is currently (76 moths) in second CR.
Conclusion.
This study suggests that when the therapeutic strategy
includes chemotherapy prior to focal RT, BIG should be considered as local
disease and does not require CSI.
Copyright 2004 American Society of Clinical Oncology All rights
reserved worldwide.
Source: http://www.asco.org/ac/1,1003,_12-002636-00_18-0026-00_19-004097,00.asp
|
