Bifocal Intracranial germinoma (BIG): Is there a place for localized radiation?

Abstract

8548 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. No significant financial relationships to disclose.