Phase II Trial of Pathology-based Tripartite Treatment Stratification for Patients with CNS Germ Cell Tumors: A Long-term Follow-up Study.

IF 16.4 1区医学 Q1 CLINICAL NEUROLOGY

Neuro-oncology Pub Date : 2024-11-02 DOI:10.1093/neuonc/noae229

Hirokazu Takami, Masao Matsutani, Tomonari Suzuki, Kazuhiko Takabatake, Takamitsu Fujimaki, Michinari Okamoto, Shigeru Yamaguchi, Masayuki Kanamori, Kenichiro Matsuda, Yukihiko Sonoda, Manabu Natsumeda, Toshiya Ichinose, Mitsutoshi Nakada, Ai Muroi, Eiichi Ishikawa, Masamichi Takahashi, Yoshitaka Narita, Shota Tanaka, Nobuhito Saito, Fumi Higuchi, Masahiro Shin, Yohei Mineharu, Yoshiki Arakawa, Naoki Kagawa, Shinji Kawabata, Masahiko Wanibuchi, Takeshi Takayasu, Fumiyuki Yamasaki, Kentaro Fujii, Joji Ishida, Isao Date, Keisuke Miyake, Yutaka Fujioka, Daisuke Kuga, Shinji Yamashita, Hideo Takeshima, Naoki Shinojima, Akitake Mukasa, Akio Asai, Ryo Nishikawa

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引用次数: 0

Abstract

Background: A previous Phase II clinical trial, conducted from 1995 to 2003, evaluated CNS germ cell tumors (GCTs) using a three-group treatment stratification based on histopathology. The primary objective of the study was to assess the long-term efficacy of standardized treatment regimens, while the secondary objective focused on identifying associated long-term complications.

Methods: Total 228 patients were classified into three groups for treatment: germinoma (n=161), intermediate prognosis (n=38), and poor prognosis (n=28), excluding one mature teratoma case. Treatment involved stratified chemotherapy regimens and varied radiation doses/coverage. Clinical data was retrospectively analyzed at a median follow-up of 18.5 years.

Results: The treatment outcomes for germinoma, with or without syncytiotrophoblastic giant cell, were similar. The 10- and 20-year event-free survival rates for the germinoma, intermediate, and poor prognosis groups were 82/76/49% and 73/66/49%, respectively. Overall survival (OS) rates were 97/87/61% at 10 years and 92/70/53% at 20 years. Germinomas in the basal ganglia, treated without whole-brain radiation therapy (WBRT), frequently relapsed but were effectively managed with subsequent WBRT. Deaths in germinoma cases had varied causes, whereas deaths in the poor prognosis group were predominantly disease-related. Nineteen treatment-related complications were identified in 16 patients, with cumulative event rates of 1.9% at 10 years and 11.3% at 20 years. OS rates at 1 and 2 years post-relapse for tumors initially classified as germinoma, intermediate, and poor prognosis were 94/88/18% and 91/50/9%, respectively.

Conclusions: Initial treatment intensity is crucial for managing non-germinomatous GCTs, while long-term follow-up for relapse and complications is imperative in germinomas. Irradiation extending beyond the immediate tumor site is essential for basal ganglia germinomas. Addressing relapse in non-germinomatous GCT remains a significant challenge.

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中枢神经系统生殖细胞肿瘤患者基于病理学的三方治疗分层 II 期试验：长期随访研究

背景：1995年至2003年期间进行的一项II期临床试验根据组织病理学对中枢神经系统生殖细胞瘤（GCT）进行了评估，采用了三组治疗分层法。该研究的主要目的是评估标准化治疗方案的长期疗效，次要目的是确定相关的长期并发症：共有228名患者被分为三组进行治疗：生殖细胞瘤（161例）、预后中等（38例）和预后差（28例），其中不包括一例成熟畸胎瘤。治疗包括分层化疗方案和不同的放射剂量/覆盖率。对中位随访 18.5 年的临床数据进行了回顾性分析：结果：生殖细胞瘤（伴有或不伴有合胞巨细胞）的治疗结果相似。胚芽瘤组、中等预后组和不良预后组的10年和20年无事件生存率分别为82/76/49%和73/66/49%。10年总生存率（OS）为97/87/61%，20年总生存率为92/70/53%。基底节的胚芽瘤在未接受全脑放射治疗（WBRT）的情况下经常复发，但在随后的WBRT治疗中得到了有效控制。胚芽瘤病例的死亡原因多种多样，而预后不良组的死亡主要与疾病有关。在16名患者中发现了19种与治疗相关的并发症，10年和20年的累积发生率分别为1.9%和11.3%。最初被列为生殖细胞瘤、中度预后和不良预后的肿瘤患者复发后1年和2年的OS率分别为94/88/18%和91/50/9%：最初的治疗强度对非胚芽瘤性GCT的治疗至关重要，而对胚芽瘤的复发和并发症进行长期随访则势在必行。对于基底节生殖细胞瘤来说，将照射范围扩大到直接肿瘤部位以外是至关重要的。应对非芽胞瘤 GCT 的复发仍是一项重大挑战。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neuro-oncology 医学-临床神经学

CiteScore

27.20

自引率

6.30%

发文量

1434

审稿时长

3-8 weeks

期刊介绍： Neuro-Oncology, the official journal of the Society for Neuro-Oncology, has been published monthly since January 2010. Affiliated with the Japan Society for Neuro-Oncology and the European Association of Neuro-Oncology, it is a global leader in the field. The journal is committed to swiftly disseminating high-quality information across all areas of neuro-oncology. It features peer-reviewed articles, reviews, symposia on various topics, abstracts from annual meetings, and updates from neuro-oncology societies worldwide.