Treatment Outcome of Response-Based Radiation Therapy in Children and Adolescents With Central Nervous System Nongerminomatous Germ Cell Tumors: Results of a Prospective Study

Int J Radiat Oncol Biol Phys. 2024 Jul 1;119(3):858-868. doi: 10.1016/j.ijrobp.2023.12.006. Epub 2023 Dec 18.


Purpose: The optimal dose and range of radiation therapy for central nervous system nongerminomatous germ cell tumors (NGGCTs) have not been uniformly established. Therefore, this study aimed to investigate the effect of individualized radiation therapy, based on the response to induction chemotherapy combined with surgery, on the prognosis of patients with NGGCTs.

Methods and materials: Based on the imaging examination and tumor markers after induction chemotherapy and pathologic results of second-look surgery, patients with NGGCT received different radiation therapy strategies, including 30.6 Gy whole ventricular irradiation + tumor-bed boost to 54 Gy, 30.6 Gy craniospinal irradiation + tumor-bed boost to 54 Gy, 36 Gy craniospinal irradiation + tumor-bed boost to 54 Gy, and 36 Gy craniospinal irradiation + 54 Gy tumor-bed boost with 45 Gy to metastatic spinal lesions.

Results: A total of 51 patients were enrolled between January 2015 and March 2021, with a median age of 10.3 years. The 3-year event-free survival and overall survival (OS) of the entire cohort were 70.2% ± 6.9% and 77.5% ± 6.0%, respectively. The 3-year OS of patients achieving partial response after induction chemotherapy was higher than that of patients with stable disease (P = .03) or progressive disease (P = .002). The 3-year event-free survival and OS of the 18 patients receiving 30.6 Gy whole ventricular irradiation and 54 Gy tumor-bed boost were 88.9% ± 7.4% and 94.4% ± 5.4%, respectively.

Conclusions: The results suggest that an individualized radiation therapy strategy based on response to induction chemotherapy and surgery is a feasible and promising means of achieving reduction in dose and extent of radiation in patients while still providing good response.

MeSH terms

  • Adolescent
  • Central Nervous System Neoplasms* / mortality
  • Central Nervous System Neoplasms* / pathology
  • Central Nervous System Neoplasms* / radiotherapy
  • Child
  • Child, Preschool
  • Craniospinal Irradiation / methods
  • Female
  • Humans
  • Induction Chemotherapy*
  • Male
  • Neoplasms, Germ Cell and Embryonal* / mortality
  • Neoplasms, Germ Cell and Embryonal* / pathology
  • Neoplasms, Germ Cell and Embryonal* / radiotherapy
  • Progression-Free Survival
  • Prospective Studies
  • Radiotherapy Dosage
  • Testicular Neoplasms / mortality
  • Testicular Neoplasms / pathology
  • Testicular Neoplasms / radiotherapy
  • Treatment Outcome

Supplementary concepts

  • Nonseminomatous germ cell tumor