Affiliation:
1. Department of Pediatrics Texas Children's Cancer Center Baylor College of Medicine Houston Texas USA
2. Division of Hematology and Oncology St. Louis Children's Hospital Washington University School of Medicine in St. Louis Washington University St. Louis Missouri USA
3. Department of Radiation Oncology University of Texas MD Anderson Cancer Center Houston Texas USA
Abstract
AbstractBackgroundThe role of neoadjuvant chemotherapy in treating patients with metastatic central nervous system (CNS) germinoma is controversial.MethodsWe compared the relapse‐free survival (RFS) of different treatment modalities by performing a meta‐analysis using published data. We summarized all data using standard descriptive statistics. We used the Kaplan–Meier method to estimate RFS and their corresponding 95% confidence intervals (CIs). We used the log‐rank test for the comparison of survival functions.ResultsWe identified 97 patients with a median age at presentation of 15 years (range: 7–38). Sites of metastasis were cerebrospinal fluid (CSF) disease only (n = 12), brain parenchyma (n = 18), spinal cord (n = 9), ventricular and CSF (n = 10), ventricular only (n = 31), and other (n = 17). The 3‐year RFS among patients who received any form of radiotherapy was 89% (95% CI: 83–96) compared with 0% for patients who received a chemotherapy‐only regimen (p = .001). Five‐year RFS among patients who received craniospinal irradiation (CSI) was 92% (95% CI: 84–100) compared with 76.4% (95% CI: 63–90) in the non‐CSI group (with or without neoadjuvant chemotherapy) (p = .014). Five‐year RFS of patients who received CSI less than 24 Gy with neoadjuvant chemotherapy was 100% compared with 92% (95% CI: 83–100) CSI dose greater than or equal to 24 Gy alone (p = .3).ConclusionsOur analysis does not support avoiding spinal irradiation among patients with radiographic metastatic CNS germinoma. Future studies are needed to confirm whether neoadjuvant chemotherapy will allow a reduction of irradiation dose without compromising survival.
Subject
Oncology,Hematology,Pediatrics, Perinatology and Child Health