Early outcomes and patterns of failure following proton remedy for nonmetastatic intracranial nongerminomatous germ cell tumors.

Pediatr Blood Most cancers. 2018 Jan 30;:

Authors: Mokhtech M, Rotondo RL, Bradley JA, Sandler ES, Nanda R, Logie N, Aldana PR, Morris CG, Indelicato DJ

Summary
BACKGROUND: Though dosimetric comparisons display the benefit of proton remedy (PT) over standard radiotherapy for nongerminomatous germ cell tumors (NGGCT), scientific end result information for this uncommon tumor are missing. We sought to judge outcomes for kids with NGGCT handled with PT.
METHODS: Between 2007 and 2016, 14 youngsters (median age 11, vary, 5-19 years) with nonmetastatic NGGCT had been handled with PT after induction chemotherapy. Most (eight/14) had been blended germ cell. 5 of 14 sufferers had full resection of their major tumor earlier than radiation. Off examine, eight sufferers acquired 36 Gy (RBE [relative biological effectiveness]) craniospinal irradiation (CSI). On examine, two sufferers acquired 30.6 Gy (RBE) whole-ventricle irradiation and 4 acquired focal radiation alone. All sufferers acquired a complete dose of 54 Gy (RBE) to the tumor/tumor mattress.
RESULTS: At a median follow-up of two.eight years, all sufferers had been alive with no native recurrences. Three-year progression-free survival was 86%. Each metastatic recurrences occurred in sufferers handled with focal radiation alone; one with an immature teratoma developed an remoted spinal recurrence 5 months after remedy. One other with a blended germ cell tumor developed a multifocal ventricular and shunt tract recurrence 7 months after remedy. Severe toxicity was minimal, together with cataracts and hormone deficiency, and restricted to youngsters who acquired CSI.
CONCLUSION: Early outcomes in youngsters handled for NGGCT counsel the excessive conformality of PT doesn’t compromise illness management and yields low toxicity. This sample of failure information provides to rising proof suggesting chemotherapy adopted by focal radiotherapy alone is insufficient in controlling localized NGGCT.

PMID: 29380526 [PubMed – as supplied by publisher]