Outcome of Children and Adolescents With Primary Intracranial Germinoma Treated With Chemotherapy and Reduced Dose-Field Irradiation: A Prospective Brazilian Experience
PURPOSEThis prospective Brazilian single-arm trial was conducted to determine response to chemotherapy and survival after response-based radiotherapy in children with intracranial germinomas, in the setting of a multi-institutional study in a middle-income country (MIC) with significant disparity of...
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| Format: | Article |
| Language: | English |
| Published: |
American Society of Clinical Oncology
2023-04-01
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| Series: | JCO Global Oncology |
| Online Access: | https://ascopubs.org/doi/10.1200/GO.22.00257 |
| _version_ | 1797844028451979264 |
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| author | Andrea Maria Cappellano Natalia Dassi Bruna Mançano Sidnei Epelman Daniela B. Almeida Sergio Cavalheiro Patricia A. Dastoli Maria Teresa Seixas Jardel M. Nicacio Marcos D. Costa Frederico A. Silva Simone S. Aguiar Carlos R. Almeida Gustavo R. Teixeira Michael Chen Maria Luisa Figueiredo Nasjla S. Silva Jonathan L. Finlay |
| author_facet | Andrea Maria Cappellano Natalia Dassi Bruna Mançano Sidnei Epelman Daniela B. Almeida Sergio Cavalheiro Patricia A. Dastoli Maria Teresa Seixas Jardel M. Nicacio Marcos D. Costa Frederico A. Silva Simone S. Aguiar Carlos R. Almeida Gustavo R. Teixeira Michael Chen Maria Luisa Figueiredo Nasjla S. Silva Jonathan L. Finlay |
| author_sort | Andrea Maria Cappellano |
| collection | DOAJ |
| description | PURPOSEThis prospective Brazilian single-arm trial was conducted to determine response to chemotherapy and survival after response-based radiotherapy in children with intracranial germinomas, in the setting of a multi-institutional study in a middle-income country (MIC) with significant disparity of subspecialty care.PATIENTS AND METHODSSince 2013, 58 patients with histologic and/or serum and CSF tumor marker evaluations of primary intracranial germ cell tumors were diagnosed; 43 were germinoma with HCGβ levels ≤200 mIU/mL and five between 100 and 200 mIU/mL. The treatment plan consisted of four cycles of carboplatin and etoposide followed by 18 Gy whole-ventricular field irradiation (WVFI) and primary site(s) boost up to 30 Gy; 24 Gy craniospinal was prescribed for disseminated disease.RESULTSMean age 13.2 years (range, 4.7-25.5 years); 29 were males. Diagnosis was made by tumor markers (n = 6), surgery (n = 25), or both (n = 10). Two bifocal cases with negative tumor markers were treated as germinoma. Primary tumor location was pineal (n = 18), suprasellar (n = 14), bifocal (n = 10), and basal ganglia/thalamus (n = 1). Fourteen had ventricular/spinal spread documented by imaging studies. Second-look surgery occurred in three patients after chemotherapy. Thirty-five patients achieved complete responses after chemotherapy, and eight showed residual teratoma/scar. Toxicity was mostly grade 3/4 neutropenia/thrombocytopenia during chemotherapy. At a median follow-up of 44.5 months, overall and event-free survivals were 100%.CONCLUSIONThe treatment is tolerable, and WVFI dose reduction to 18 Gy preserves efficacy; we have demonstrated the feasibility of successfully conducting a prospective multicenter trial in a large MIC despite resource disparity. |
| first_indexed | 2024-04-09T17:15:49Z |
| format | Article |
| id | doaj.art-128c97d18f234ebca10bb23a35b0d5b6 |
| institution | Directory Open Access Journal |
| issn | 2687-8941 |
| language | English |
| last_indexed | 2024-04-09T17:15:49Z |
| publishDate | 2023-04-01 |
| publisher | American Society of Clinical Oncology |
| record_format | Article |
| series | JCO Global Oncology |
| spelling | doaj.art-128c97d18f234ebca10bb23a35b0d5b62023-04-19T19:58:50ZengAmerican Society of Clinical OncologyJCO Global Oncology2687-89412023-04-01910.1200/GO.22.00257Outcome of Children and Adolescents With Primary Intracranial Germinoma Treated With Chemotherapy and Reduced Dose-Field Irradiation: A Prospective Brazilian ExperienceAndrea Maria Cappellano0Natalia Dassi1Bruna Mançano2Sidnei Epelman3Daniela B. Almeida4Sergio Cavalheiro5Patricia A. Dastoli6Maria Teresa Seixas7Jardel M. Nicacio8Marcos D. Costa9Frederico A. Silva10Simone S. Aguiar11Carlos R. Almeida12Gustavo R. Teixeira13Michael Chen14Maria Luisa Figueiredo15Nasjla S. Silva16Jonathan L. Finlay17Pediatric Oncology, IOP-GRAACC, Federal University of São Paulo, São Paulo, BrazilPediatric Oncology, IOP-GRAACC, Federal University of São Paulo, São Paulo, BrazilPediatric Oncology, Hospital do Amor, Barretos, BrazilPediatric Oncology, Hospital Santa Marcelina, TUCCA, São Paulo, BrazilNursing Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, BrazilNeurosurgery Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, BrazilNeurosurgery Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, BrazilPathology Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, BrazilNeurosurgery Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, BrazilNeurosurgery Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, BrazilRadiology Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, BrazilPediatric Oncology, IOP-GRAACC, Federal University of São Paulo, São Paulo, BrazilNeurosurgery Department, Hospital do Amor, Barretos, BrazilPathology Department, Hospital do Amor, Barretos, BrazilRadiotherapy Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, BrazilRadiotherapy Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, BrazilPediatric Oncology, IOP-GRAACC, Federal University of São Paulo, São Paulo, BrazilPaediatric Oncology, The Ohio State University, Columbus, OHPURPOSEThis prospective Brazilian single-arm trial was conducted to determine response to chemotherapy and survival after response-based radiotherapy in children with intracranial germinomas, in the setting of a multi-institutional study in a middle-income country (MIC) with significant disparity of subspecialty care.PATIENTS AND METHODSSince 2013, 58 patients with histologic and/or serum and CSF tumor marker evaluations of primary intracranial germ cell tumors were diagnosed; 43 were germinoma with HCGβ levels ≤200 mIU/mL and five between 100 and 200 mIU/mL. The treatment plan consisted of four cycles of carboplatin and etoposide followed by 18 Gy whole-ventricular field irradiation (WVFI) and primary site(s) boost up to 30 Gy; 24 Gy craniospinal was prescribed for disseminated disease.RESULTSMean age 13.2 years (range, 4.7-25.5 years); 29 were males. Diagnosis was made by tumor markers (n = 6), surgery (n = 25), or both (n = 10). Two bifocal cases with negative tumor markers were treated as germinoma. Primary tumor location was pineal (n = 18), suprasellar (n = 14), bifocal (n = 10), and basal ganglia/thalamus (n = 1). Fourteen had ventricular/spinal spread documented by imaging studies. Second-look surgery occurred in three patients after chemotherapy. Thirty-five patients achieved complete responses after chemotherapy, and eight showed residual teratoma/scar. Toxicity was mostly grade 3/4 neutropenia/thrombocytopenia during chemotherapy. At a median follow-up of 44.5 months, overall and event-free survivals were 100%.CONCLUSIONThe treatment is tolerable, and WVFI dose reduction to 18 Gy preserves efficacy; we have demonstrated the feasibility of successfully conducting a prospective multicenter trial in a large MIC despite resource disparity.https://ascopubs.org/doi/10.1200/GO.22.00257 |
| spellingShingle | Andrea Maria Cappellano Natalia Dassi Bruna Mançano Sidnei Epelman Daniela B. Almeida Sergio Cavalheiro Patricia A. Dastoli Maria Teresa Seixas Jardel M. Nicacio Marcos D. Costa Frederico A. Silva Simone S. Aguiar Carlos R. Almeida Gustavo R. Teixeira Michael Chen Maria Luisa Figueiredo Nasjla S. Silva Jonathan L. Finlay Outcome of Children and Adolescents With Primary Intracranial Germinoma Treated With Chemotherapy and Reduced Dose-Field Irradiation: A Prospective Brazilian Experience JCO Global Oncology |
| title | Outcome of Children and Adolescents With Primary Intracranial Germinoma Treated With Chemotherapy and Reduced Dose-Field Irradiation: A Prospective Brazilian Experience |
| title_full | Outcome of Children and Adolescents With Primary Intracranial Germinoma Treated With Chemotherapy and Reduced Dose-Field Irradiation: A Prospective Brazilian Experience |
| title_fullStr | Outcome of Children and Adolescents With Primary Intracranial Germinoma Treated With Chemotherapy and Reduced Dose-Field Irradiation: A Prospective Brazilian Experience |
| title_full_unstemmed | Outcome of Children and Adolescents With Primary Intracranial Germinoma Treated With Chemotherapy and Reduced Dose-Field Irradiation: A Prospective Brazilian Experience |
| title_short | Outcome of Children and Adolescents With Primary Intracranial Germinoma Treated With Chemotherapy and Reduced Dose-Field Irradiation: A Prospective Brazilian Experience |
| title_sort | outcome of children and adolescents with primary intracranial germinoma treated with chemotherapy and reduced dose field irradiation a prospective brazilian experience |
| url | https://ascopubs.org/doi/10.1200/GO.22.00257 |
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