Treatment Outcomes for Response-based Radiotherapy in Children and Adolescents with Central Nervous System Germinoma: a Prospective Study

Abstract

Abstract Purpose 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. Methods Based on imaging examination, tumor markers, and pathologic results, patients with germinoma received different radiotherapy strategies, including R1 (24 Gy whole ventricular irradiation and 40 Gy tumor-bed boost), R2 (24–30 Gy craniospinal irradiation and 54 Gy tumor-bed boost), R3 (24 Gy craniospinal irradiation and 40 Gy tumor-bed boost), and R4 (30 Gy craniospinal irradiation and 54 Gy tumor-bed boost with 45 Gy to metastatic spinal lesions). Results 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. Conclusion Compared to previous studies, radiotherapy intensities were decreased without compromising the treatment outcomes in selected patients. This study suggests that an individualized radiotherapy strategy in patients with germinoma based on the response to induction chemotherapy and surgery is feasible and could decrease radiotherapy-related side effects in specific patients.