Phase II Trial of Pathology-based Tripartite Treatment Stratification for Patients with CNS Germ Cell Tumors: A Long-term Follow-up Study
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...
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| creator | Takami, Hirokazu Matsutani, Masao Suzuki, Tomonari Takabatake, Kazuhiko Fujimaki, Takamitsu Okamoto, Michinari Yamaguchi, Shigeru Kanamori, Masayuki Matsuda, Kenichiro Sonoda, Yukihiko Natsumeda, Manabu Ichinose, Toshiya Nakada, Mitsutoshi Muroi, Ai Ishikawa, Eiichi Takahashi, Masamichi Narita, Yoshitaka Tanaka, Shota Saito, Nobuhito Higuchi, Fumi Shin, Masahiro Mineharu, Yohei Arakawa, Yoshiki Kagawa, Naoki Kawabata, Shinji Wanibuchi, Masahiko Takayasu, Takeshi Yamasaki, Fumiyuki Fujii, Kentaro Ishida, Joji Date, Isao Miyake, Keisuke Fujioka, Yutaka Kuga, Daisuke Yamashita, Shinji Takeshima, Hideo Shinojima, Naoki Mukasa, Akitake Asai, Akio Nishikawa, Ryo |
| description | 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.
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.
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.
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. |
| doi_str_mv | 10.1093/neuonc/noae229 |
| format | Article |
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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.
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.
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.</description><identifier>ISSN: 1522-8517</identifier><identifier>ISSN: 1523-5866</identifier><identifier>EISSN: 1523-5866</identifier><identifier>DOI: 10.1093/neuonc/noae229</identifier><identifier>PMID: 39492661</identifier><language>eng</language><publisher>England</publisher><ispartof>Neuro-oncology (Charlottesville, Va.), 2024-11</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c180t-4e3eca6e85d775cc96faeeda98e4a80297e3d90cab43f8ee26f98f42c4e4373b3</cites><orcidid>0000-0003-0164-6295 ; 0000-0003-4303-6006 ; 0000-0001-5617-8068 ; 0000-0001-9742-7462 ; 0000-0003-4626-4645 ; 0000-0002-3380-1192</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27922,27923</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39492661$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Takami, Hirokazu</creatorcontrib><creatorcontrib>Matsutani, Masao</creatorcontrib><creatorcontrib>Suzuki, Tomonari</creatorcontrib><creatorcontrib>Takabatake, Kazuhiko</creatorcontrib><creatorcontrib>Fujimaki, Takamitsu</creatorcontrib><creatorcontrib>Okamoto, Michinari</creatorcontrib><creatorcontrib>Yamaguchi, Shigeru</creatorcontrib><creatorcontrib>Kanamori, Masayuki</creatorcontrib><creatorcontrib>Matsuda, Kenichiro</creatorcontrib><creatorcontrib>Sonoda, Yukihiko</creatorcontrib><creatorcontrib>Natsumeda, Manabu</creatorcontrib><creatorcontrib>Ichinose, Toshiya</creatorcontrib><creatorcontrib>Nakada, Mitsutoshi</creatorcontrib><creatorcontrib>Muroi, Ai</creatorcontrib><creatorcontrib>Ishikawa, Eiichi</creatorcontrib><creatorcontrib>Takahashi, Masamichi</creatorcontrib><creatorcontrib>Narita, Yoshitaka</creatorcontrib><creatorcontrib>Tanaka, Shota</creatorcontrib><creatorcontrib>Saito, Nobuhito</creatorcontrib><creatorcontrib>Higuchi, Fumi</creatorcontrib><creatorcontrib>Shin, Masahiro</creatorcontrib><creatorcontrib>Mineharu, Yohei</creatorcontrib><creatorcontrib>Arakawa, Yoshiki</creatorcontrib><creatorcontrib>Kagawa, Naoki</creatorcontrib><creatorcontrib>Kawabata, Shinji</creatorcontrib><creatorcontrib>Wanibuchi, Masahiko</creatorcontrib><creatorcontrib>Takayasu, Takeshi</creatorcontrib><creatorcontrib>Yamasaki, Fumiyuki</creatorcontrib><creatorcontrib>Fujii, Kentaro</creatorcontrib><creatorcontrib>Ishida, Joji</creatorcontrib><creatorcontrib>Date, Isao</creatorcontrib><creatorcontrib>Miyake, Keisuke</creatorcontrib><creatorcontrib>Fujioka, Yutaka</creatorcontrib><creatorcontrib>Kuga, Daisuke</creatorcontrib><creatorcontrib>Yamashita, Shinji</creatorcontrib><creatorcontrib>Takeshima, Hideo</creatorcontrib><creatorcontrib>Shinojima, Naoki</creatorcontrib><creatorcontrib>Mukasa, Akitake</creatorcontrib><creatorcontrib>Asai, Akio</creatorcontrib><creatorcontrib>Nishikawa, Ryo</creatorcontrib><title>Phase II Trial of Pathology-based Tripartite Treatment Stratification for Patients with CNS Germ Cell Tumors: A Long-term Follow-up Study</title><title>Neuro-oncology (Charlottesville, Va.)</title><addtitle>Neuro Oncol</addtitle><description>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.
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.
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.
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. 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Matsutani, Masao ; Suzuki, Tomonari ; Takabatake, Kazuhiko ; Fujimaki, Takamitsu ; Okamoto, Michinari ; Yamaguchi, Shigeru ; Kanamori, Masayuki ; Matsuda, Kenichiro ; Sonoda, Yukihiko ; Natsumeda, Manabu ; Ichinose, Toshiya ; Nakada, Mitsutoshi ; Muroi, Ai ; Ishikawa, Eiichi ; Takahashi, Masamichi ; Narita, Yoshitaka ; Tanaka, Shota ; Saito, Nobuhito ; Higuchi, Fumi ; Shin, Masahiro ; Mineharu, Yohei ; Arakawa, Yoshiki ; Kagawa, Naoki ; Kawabata, Shinji ; Wanibuchi, Masahiko ; Takayasu, Takeshi ; Yamasaki, Fumiyuki ; Fujii, Kentaro ; Ishida, Joji ; Date, Isao ; Miyake, Keisuke ; Fujioka, Yutaka ; Kuga, Daisuke ; Yamashita, Shinji ; Takeshima, Hideo ; Shinojima, Naoki ; Mukasa, Akitake ; Asai, Akio ; Nishikawa, Ryo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c180t-4e3eca6e85d775cc96faeeda98e4a80297e3d90cab43f8ee26f98f42c4e4373b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Takami, Hirokazu</creatorcontrib><creatorcontrib>Matsutani, Masao</creatorcontrib><creatorcontrib>Suzuki, Tomonari</creatorcontrib><creatorcontrib>Takabatake, Kazuhiko</creatorcontrib><creatorcontrib>Fujimaki, Takamitsu</creatorcontrib><creatorcontrib>Okamoto, Michinari</creatorcontrib><creatorcontrib>Yamaguchi, Shigeru</creatorcontrib><creatorcontrib>Kanamori, Masayuki</creatorcontrib><creatorcontrib>Matsuda, Kenichiro</creatorcontrib><creatorcontrib>Sonoda, Yukihiko</creatorcontrib><creatorcontrib>Natsumeda, Manabu</creatorcontrib><creatorcontrib>Ichinose, Toshiya</creatorcontrib><creatorcontrib>Nakada, Mitsutoshi</creatorcontrib><creatorcontrib>Muroi, Ai</creatorcontrib><creatorcontrib>Ishikawa, Eiichi</creatorcontrib><creatorcontrib>Takahashi, Masamichi</creatorcontrib><creatorcontrib>Narita, Yoshitaka</creatorcontrib><creatorcontrib>Tanaka, Shota</creatorcontrib><creatorcontrib>Saito, Nobuhito</creatorcontrib><creatorcontrib>Higuchi, Fumi</creatorcontrib><creatorcontrib>Shin, Masahiro</creatorcontrib><creatorcontrib>Mineharu, Yohei</creatorcontrib><creatorcontrib>Arakawa, Yoshiki</creatorcontrib><creatorcontrib>Kagawa, Naoki</creatorcontrib><creatorcontrib>Kawabata, Shinji</creatorcontrib><creatorcontrib>Wanibuchi, Masahiko</creatorcontrib><creatorcontrib>Takayasu, Takeshi</creatorcontrib><creatorcontrib>Yamasaki, Fumiyuki</creatorcontrib><creatorcontrib>Fujii, Kentaro</creatorcontrib><creatorcontrib>Ishida, Joji</creatorcontrib><creatorcontrib>Date, Isao</creatorcontrib><creatorcontrib>Miyake, Keisuke</creatorcontrib><creatorcontrib>Fujioka, Yutaka</creatorcontrib><creatorcontrib>Kuga, Daisuke</creatorcontrib><creatorcontrib>Yamashita, Shinji</creatorcontrib><creatorcontrib>Takeshima, Hideo</creatorcontrib><creatorcontrib>Shinojima, Naoki</creatorcontrib><creatorcontrib>Mukasa, Akitake</creatorcontrib><creatorcontrib>Asai, Akio</creatorcontrib><creatorcontrib>Nishikawa, Ryo</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Neuro-oncology (Charlottesville, Va.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Takami, Hirokazu</au><au>Matsutani, Masao</au><au>Suzuki, Tomonari</au><au>Takabatake, Kazuhiko</au><au>Fujimaki, Takamitsu</au><au>Okamoto, Michinari</au><au>Yamaguchi, Shigeru</au><au>Kanamori, Masayuki</au><au>Matsuda, Kenichiro</au><au>Sonoda, Yukihiko</au><au>Natsumeda, Manabu</au><au>Ichinose, Toshiya</au><au>Nakada, Mitsutoshi</au><au>Muroi, Ai</au><au>Ishikawa, Eiichi</au><au>Takahashi, Masamichi</au><au>Narita, Yoshitaka</au><au>Tanaka, Shota</au><au>Saito, Nobuhito</au><au>Higuchi, Fumi</au><au>Shin, Masahiro</au><au>Mineharu, Yohei</au><au>Arakawa, Yoshiki</au><au>Kagawa, Naoki</au><au>Kawabata, Shinji</au><au>Wanibuchi, Masahiko</au><au>Takayasu, Takeshi</au><au>Yamasaki, Fumiyuki</au><au>Fujii, Kentaro</au><au>Ishida, Joji</au><au>Date, Isao</au><au>Miyake, Keisuke</au><au>Fujioka, Yutaka</au><au>Kuga, Daisuke</au><au>Yamashita, Shinji</au><au>Takeshima, Hideo</au><au>Shinojima, Naoki</au><au>Mukasa, Akitake</au><au>Asai, Akio</au><au>Nishikawa, Ryo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Phase II Trial of Pathology-based Tripartite Treatment Stratification for Patients with CNS Germ Cell Tumors: A Long-term Follow-up Study</atitle><jtitle>Neuro-oncology (Charlottesville, Va.)</jtitle><addtitle>Neuro Oncol</addtitle><date>2024-11-02</date><risdate>2024</risdate><issn>1522-8517</issn><issn>1523-5866</issn><eissn>1523-5866</eissn><abstract>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.
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.
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.
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.</abstract><cop>England</cop><pmid>39492661</pmid><doi>10.1093/neuonc/noae229</doi><orcidid>https://orcid.org/0000-0003-0164-6295</orcidid><orcidid>https://orcid.org/0000-0003-4303-6006</orcidid><orcidid>https://orcid.org/0000-0001-5617-8068</orcidid><orcidid>https://orcid.org/0000-0001-9742-7462</orcidid><orcidid>https://orcid.org/0000-0003-4626-4645</orcidid><orcidid>https://orcid.org/0000-0002-3380-1192</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1522-8517 |
| ispartof | Neuro-oncology (Charlottesville, Va.), 2024-11 |
| issn | 1522-8517 1523-5866 1523-5866 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_3123805245 |
| source | Oxford University Press Journals All Titles (1996-Current) |
| title | Phase II Trial of Pathology-based Tripartite Treatment Stratification for Patients with CNS Germ Cell Tumors: A Long-term Follow-up Study |
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