Treatment and outcomes of UK and German patients with relapsed intracranial germ cell tumors following uniform first-line therapy

Abstract

We aimed to retrospectively assess treatments/outcomes, including the value of high-dose-chemotherapy and autologous-stem-cell-rescue (HDC+AuSCR) and re-irradiation, in a large, European patient-cohort with relapsed intracranial germ-cell-tumors (GCTs) receiving uniform first-line therapy, including radiotherapy as standard-of-care. Fifty-eight UK/German patients (48 male/10 female) with relapsed intracranial-GCTs [13 germinoma/45 non-germinomatous GCT(NGGCT)] treated 1996-2010 as per the SIOP-CNS-GCT-96 protocol were evaluated. For germinoma, six patients relapsed with germinoma and five with NGGCT (one palliative, one teratoma patient excluded). Five-year overall-survival (OS) for the whole-group (n=11) was 55%. Four of six germinoma relapses and two of five relapsing with NGGCT were salvaged; patients were salvaged with either standard-dose-chemotherapy (SDC) and re-irradiation or HDC+AuSCR with/without re-irradiation. Of 45 relapsed NGGCT patients, 13 were excluded (3 non-protocol adherence, 5 teratoma, 5 palliation). Five-year OS for the remaining 32 relapsed malignant NGGCT patients treated with curative intent was 9%(95%CI: 2-26%). By treatment received, 5-year OS for the 10 patients receiving SDC and 22 patients treated with intention for HDC+AuSCR was 0%(0-0%) and 14%(3-36%), respectively. The three relapsed NGGCT survivors had raised HCG markers alone; two received additional irradiation. Patients with relapsed germinoma had better 5-year OS than those with relapsed NGGCT (55%vs.9%; p=0.007). Patients with relapsed germinoma were salvaged both with SDC and re-irradiation or HDC+AuSCR with/without re-irradiation; which both represent valid treatment options. Outcomes for malignant relapse following initial diagnosis of NGGCT were exceptionally poor; the few survivors received thiotepa-based HDC+AuSCR, which is a treatment option at first malignant relapse for such patients, with further surgery/irradiation where feasible. This article is protected by copyright. All rights reserved.

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