Treatment outcomes for response-based radiotherapy in children and adolescents with central nervous system germinoma: a prospective study.

Abstract

The optimal dose and range of radiotherapy for central nervous system (CNS) germinoma have not yet been established. This study aimed to investigate the effects of individualized radiotherapy on the prognosis of patients with germinoma. Based on imaging examination, tumor markers, and pathologic results, patients with germinoma received different radiotherapy strategies, including R1 (24Gy whole ventricular irradiation + tumor-bed boost to 40Gy), R2 (24-30Gy craniospinal irradiation + tumor-bed boost to 54Gy), R3 (24Gy craniospinal irradiation + tumor-bed boost to 40Gy), and R4 (30Gy craniospinal irradiation + tumor-bed boost to 54Gy with 45Gy to spinal metastasis). A total of 77 patients were enrolled in this study between January 2015 and March 2021. The 3-year event-free survival (EFS) and overall survival (OS) of the whole cohort were 94.7% ± 2.6% and 96.0% ± 2.3%, respectively. The 3-year EFS for patients with localized and metastatic disease were 96.6% ± 2.4% and 89.2% ± 7.2%, respectively. The 3-year EFS of patients receiving R1, R2, R3, and R4 radiotherapy were 100%, 94.1% ± 5.7%, 100%, and 86.2% ± 9.1%, respectively. Good prognosis was still achieved after reducing dose and extent of radiation for the patients who achieved complete response (CR) after induction chemotherapy or pathological CR after second-look surgery.