Improvement of Long-term Results with Neoadjuvant Chemotherapy and Radiotherapy for Central Nervous System Germinoma

Objective To evaluate the role of neoadjuvant chemotherapy and radiotherapy in the treatment of central nervous system germinomas in 38 patients who received definitive treatment and were followed-up >5 years between 1980 and 2009. Methods The median age at diagnosis and follow-up period were 16.5 years and 128.3 months, respectively. Treatment was irradiation alone or adjuvant platinum-based chemotherapy followed by reduced-dose local irradiation. Seven patients progressed at 12.9–133.9 months and 1 died of disease 89.3 months after therapy initiation. Results The treatment strategies were divided into 3 groups: group A (1980–1988, n = 5), whole brain with local irradiation; group B (1989–2002, n = 16), chemotherapy with or without reduced irradiation dose; and group C (2003–2009, n = 17): neoadjuvant chemotherapy (3 courses) followed by 30.6 Gy of whole ventricle irradiation for patients with localized complete response, and additional local boost of 19.8 Gy for others. There were 7 recurrent cases, all in group B. The progression-free survival was significantly longer in groups A and C versus group B ( P