GCT-16. Management of Patients with Metastatic Central Nervous System (CNS) Germinoma; A Literature Review

Abstract

Abstract BACKGROUND: Outcomes of patients with primary metastatic CNS Germinoma are excellent. There is no global consensus over the optimal irradiation doses and fields to reduce long-term radiotherapy side effects. Our literature review explores the different treatment modalities utilized for patients with metastatic CNS germinoma. METHODS: A literature review of studies that included patients with primary metastatic CNS germinoma via PubMed database. RESULTS: Sixty-eight patients (male: 48, female: 13, not specified: 7) were identified. At presentation, the median age was 14.4 years (range: 1.5–47 years). Primary tumor location included the following: pineal (n=15), suprasellar (n=11), bifocal (suprasellar and pineal) (n=21), other (n=9), not specified (n=12). Metastasis sites included the following: multifocal intracranial with/without ventricular metastasis (n=18), ventricular metastasis only (n=21), spinal metastasis only (n=8), CSF cytology dissemination only (n=3), and not specified (n=18). Seventeen patients received radiotherapy only, and 51 received radio-chemotherapy. Radiotherapy modalities included the following: craniospinal irradiation (n=36) with a mean whole-brain dose of 23.3 Gy (range:10.8-40.5 Gy) and spinal dose of 21.6 Gy (range: 10.8 – 30.6 Gy), whole-brain irradiation (n=13) with a mean dose of 24.2 Gy (range: 18 - 40 Gy), whole ventricular irradiation (n=16) with a mean dose of 24.7 Gy (range: 23.4 – 30 Gy), Focal irradiation only (n=1) with a dose of 40 Gy, and not specified (n=2). Four patients died of disease progression or relapse. Two patients were alive with relapse/residual disease. Sixty-two patients were alive with no evidence of disease with a mean follow of 77 months (range: 10.3 – 256 months). Further analysis is underway and will be presented at the meeting. CONCLUSION: The role of neoadjuvant chemotherapy in reducing the dose and field of radiation therapy remains unclear. Further analysis is pending which may highlight the role of neoadjuvant chemotherapy in managing patients with metastatic germinoma.