RADT-42. STRATEGIES FOR TREATING RECURRENT GERM CELL TUMORS IN PATIENTS WHO HAVE UNDERGONE PRIOR CHEMORADIOTHERAPY AGAINST PRIMARY GERMINOMA

Abstract

Abstract BACKGROUND Germinoma patients are thought to have a favorable prognosis due to their high sensitivity to chemotherapy and radiotherapy. However, it is also known that germinoma is at risk of recurrence after a long course of disease. Despite excellent sensitivity to chemotherapy and radiotherapy, there is no established standard treatment for patients with recurrent germinoma. METHODS Fourteen patients with recurrent germinoma treated in our institution from 1989 to 2022 were included in this retrospective study. All patients were treated for primary tumor with carboplatin-etoposide and 23.4 Gy of whole ventricle/whole brain irradiation. Twelve patients were treated at our institution at primary and first recurrence, and three patients were referred to our institutional for management against recurrent tumors. Medical records were examined to determine the course of the disease at the time of initial onset, the first recurrence, and the following course, including recurrence and survival. RESULTS There were 12 male and 2 female patients with recurrent germinoma, age at initial onset ranged from 11 to 29 years (median 18.5 years), and age at first recurrence ranged from 16 to 36 years (median 23.5 years). The time from the date of treatment initiation against primary tumor to first confirmed recurrence ranged from 4.2 to 272 months (median 79 months). Eleven patients had recurrences outside the irradiation field, with six experiencing spinal recurrence. Thirteen patients received chemotherapy, and 12 patients had radiotherapy, including eight patients treated with craniospinal irradiation (CSI). There were no reported cases of recurrence or mortality in the CSI-treated group. In contrast, the median PFS and OS in the group that did not receive CSI were 12 and 36 months, respectively, which were significantly different from the CSI-treated group (P < 0.05). CONCLUSION Our findings suggest that CSI has an important role in reducing the likelihood of future recurrence.