Non-gonadal Germinomas – pro
Germinoma is primarily a disease of young males. There are germinomas that arise in the testicles and those that do not. It is presumed that the non-testicular germinoma have their origin in germ cells left behind during the development of the fetus. The current World Health Organization classification of Germ Cell Tumors (GCT), which is based primarily on histological elements, divides these tumors into the following major forms: Germinoma – Pure and with syncytiotrophoblasts, constituting 65%, NGGCT(non-gonadal, meaning non-testicular or ovarian)s, Teratoma – Mature and malignant, Embryonal carcinoma, Yolk sac, choriocarcinoma, endodermal sinus tumor and mixed, which combines these different elements.
Surgery and radiation are mainstays of treatment. For NGCGT, chemotherapy prolongs survival. As with gonadal germ cell tumors, the agents that have best activity against CNS GCTs are cisplatin, etoposide, vinblastine, bleomycin, and carboplatin. Ifosfamide and cyclophosphamide are also effective. High-dose chemotherapy followed by autologous stem cell transplant may be effective for patients who relapse.
A randomized, controlled trial compared conventional doses of salvage chemotherapy to high-dose chemotherapy with autologous marrow rescue in 263 patients with recurrent or refractory germ cell tumors. Of the 263 patients, 43 of whom had extragonadal primary tumors, more toxic effects and treatment-related deaths were seen in the high-dose arm without any improvement in response rate or overall survival.(PICO eet al, PDQ – Level of evidence: 1iiA]
PDQ 2012
http://www.cancer.gov/cancertopics/pdq/treatment/extragonadal-germ-cell/HealthProfessional/page1/AllPages#6-up of dose-adapted and reduced-field radiotherapy with or without chemotherapy for central nervous system germinoma. Int J Radiat Oncol Biol Phys 2010; 77:1449.
Kretschmar C, Kleinberg L, Greenberg M, et al. Pre-radiation chemotherapy with response-based radiation therapy in children with central nervous system germ cell tumors: a report from the Children’s Oncology Group. Pediatr Blood Cancer 2007; 48:285.
Alapetite C, Brisse H, Patte C, et al. Pattern of relapse and outcome of non-metastatic germinoma patients treated with chemotherapy and limited field radiation: the SFOP experience. Neuro Oncol 2010; 12:1318.
Bouffet E. The role of myeloablative chemotherapy with autologous hematopoietic cell rescue in central nervous system germ cell tumors. Pediatr Blood Cancer 2010; 54:644.
da Silva NS, Cappellano AM, Diez B, et al. Primary chemotherapy for intracranial germ cell tumors: results of the third international CNS germ cell tumor study. Pediatr Blood Cancer 2010; 54:377.
Pico JL, Rosti G, Kramar A, et al.: A randomised trial of high-dose chemotherapy in the salvage treatment of patients failing first-line platinum chemotherapy for advanced germ cell tumours. Ann Oncol 16 (7): 1152-9, 2005
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