Multi-institutional analysis of treatment modalities in basal ganglia and thalamic germinoma

Richard T. Graham; Mohammad H. Abu-Arja; Joseph R. Stanek; Andrea Cappellano; Christina Coleman; Susan Chi; Tabitha Cooney; Girish Dhall; Jacob G. Ellen; Jonathan L. Finlay; Michael J. Fisher; Gregory K. Friedman; Amar Gajjar; Karen Gauvain; Lindsey M. Hoffman; Juliette Hukin; John T. Lucas; Sabine Mueller; Pournima Navalkele; Rebecca Ronsley; Christopher Tinkle; Stephanie Villeneuve; Kee Kiat Yeo; Jack M. Su; Ashley Margol; Nicholas G. Gottardo; Jeffrey Allen; Roger Packer; Ute Bartels; Mohamed S. Abdelbaki

doi:10.1002/pbc.29172

Multi-institutional analysis of treatment modalities in basal ganglia and thalamic germinoma

Richard T. Graham, Mohammad H. Abu-Arja, Joseph R. Stanek, Andrea Cappellano, Christina Coleman, Susan Chi, Tabitha Cooney, Girish Dhall, Jacob G. Ellen, Jonathan L. Finlay, Michael J. Fisher, Gregory K. Friedman, Amar Gajjar, Karen Gauvain, Lindsey M. Hoffman, Juliette Hukin, John T. Lucas, Sabine Mueller, Pournima Navalkele, Rebecca RonsleyChristopher Tinkle, Stephanie Villeneuve, Kee Kiat Yeo, Jack M. Su, Ashley Margol, Nicholas G. Gottardo, Jeffrey Allen, Roger Packer, Ute Bartels, Mohamed S. Abdelbaki

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Abstract

Background: Central nervous system (CNS) germinomas are treatment-sensitive tumors with excellent survival outcomes. Current treatment strategies combine chemotherapy with radiotherapy (RT) in order to reduce the field and dose of RT. Germinomas originating in the basal ganglia/thalamus (BGTGs) have proven challenging to treat given their rarity and poorly defined imaging characteristics. Craniospinal (CSI), whole brain (WBI), whole ventricle (WVI), and focal RT have all been utilized; however, the best treatment strategy remains unclear. Methods: Retrospective multi-institutional analysis has been conducted across 18 institutions in four countries. Results: For 43 cases of nonmetastatic BGTGs, the 5- and 10-year event-free survivals (EFS) were 85.8% and 81.0%, respectively, while the 5- and 10-year overall survivals (OS) were 100% and 95.5%, respectively (one patient fatality from unrelated cause). Median RT doses were as follows: CSI: 2250 cGy/cGy(RBE) (1980–2400); WBI: 2340 cGy/cGy(RBE) (1800–3000); WVI: 2340 cGy/cGy(RBE) (1800–2550); focal: 3600 cGy (3060–5400). Thirty-eight patients (90.5%) received chemotherapy. There was no statistically significant difference in the EFS based on initial field extent (p =.84). Nevertheless, no relapses were reported in patients who received CSI or WBI. Chemotherapy alone had significantly inferior EFS compared to combined therapy (p =.0092), but patients were salvageable with RT. Conclusion: Patients with BGTGs have excellent outcomes and RT proved to be an integral component of the treatment plan. This group of patients should be included in future prospective clinical trials and the best RT field should be investigated further.

Original language	English
Article number	e29172
Journal	Pediatric Blood and Cancer
Volume	68
Issue number	10
DOIs	https://doi.org/10.1002/pbc.29172
State	Published - Oct 2021

Keywords

basal ganglia
chemotherapy
germinoma
pure germinoma
radiation therapy
thalamus

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10.1002/pbc.29172

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Graham, R. T., Abu-Arja, M. H., Stanek, J. R., Cappellano, A., Coleman, C., Chi, S., Cooney, T., Dhall, G., Ellen, J. G., Finlay, J. L., Fisher, M. J., Friedman, G. K., Gajjar, A., Gauvain, K., Hoffman, L. M., Hukin, J., Lucas, J. T., Mueller, S., Navalkele, P., ... Abdelbaki, M. S. (2021). Multi-institutional analysis of treatment modalities in basal ganglia and thalamic germinoma. Pediatric Blood and Cancer, 68(10), Article e29172. https://doi.org/10.1002/pbc.29172

@article{d71085fea1ea470db9d87eec76a9c32c,

title = "Multi-institutional analysis of treatment modalities in basal ganglia and thalamic germinoma",

abstract = "Background: Central nervous system (CNS) germinomas are treatment-sensitive tumors with excellent survival outcomes. Current treatment strategies combine chemotherapy with radiotherapy (RT) in order to reduce the field and dose of RT. Germinomas originating in the basal ganglia/thalamus (BGTGs) have proven challenging to treat given their rarity and poorly defined imaging characteristics. Craniospinal (CSI), whole brain (WBI), whole ventricle (WVI), and focal RT have all been utilized; however, the best treatment strategy remains unclear. Methods: Retrospective multi-institutional analysis has been conducted across 18 institutions in four countries. Results: For 43 cases of nonmetastatic BGTGs, the 5- and 10-year event-free survivals (EFS) were 85.8% and 81.0%, respectively, while the 5- and 10-year overall survivals (OS) were 100% and 95.5%, respectively (one patient fatality from unrelated cause). Median RT doses were as follows: CSI: 2250 cGy/cGy(RBE) (1980–2400); WBI: 2340 cGy/cGy(RBE) (1800–3000); WVI: 2340 cGy/cGy(RBE) (1800–2550); focal: 3600 cGy (3060–5400). Thirty-eight patients (90.5%) received chemotherapy. There was no statistically significant difference in the EFS based on initial field extent (p =.84). Nevertheless, no relapses were reported in patients who received CSI or WBI. Chemotherapy alone had significantly inferior EFS compared to combined therapy (p =.0092), but patients were salvageable with RT. Conclusion: Patients with BGTGs have excellent outcomes and RT proved to be an integral component of the treatment plan. This group of patients should be included in future prospective clinical trials and the best RT field should be investigated further.",

keywords = "basal ganglia, chemotherapy, germinoma, pure germinoma, radiation therapy, thalamus",

author = "Graham, {Richard T.} and Abu-Arja, {Mohammad H.} and Stanek, {Joseph R.} and Andrea Cappellano and Christina Coleman and Susan Chi and Tabitha Cooney and Girish Dhall and Ellen, {Jacob G.} and Finlay, {Jonathan L.} and Fisher, {Michael J.} and Friedman, {Gregory K.} and Amar Gajjar and Karen Gauvain and Hoffman, {Lindsey M.} and Juliette Hukin and Lucas, {John T.} and Sabine Mueller and Pournima Navalkele and Rebecca Ronsley and Christopher Tinkle and Stephanie Villeneuve and Yeo, {Kee Kiat} and Su, {Jack M.} and Ashley Margol and Gottardo, {Nicholas G.} and Jeffrey Allen and Roger Packer and Ute Bartels and Abdelbaki, {Mohamed S.}",

note = "Publisher Copyright: {\textcopyright} 2021 Wiley Periodicals LLC",

year = "2021",

month = oct,

doi = "10.1002/pbc.29172",

language = "English",

volume = "68",

journal = "Pediatric Blood and Cancer",

issn = "1545-5009",

number = "10",

}

Graham, RT, Abu-Arja, MH, Stanek, JR, Cappellano, A, Coleman, C, Chi, S, Cooney, T, Dhall, G, Ellen, JG, Finlay, JL, Fisher, MJ, Friedman, GK, Gajjar, A, Gauvain, K, Hoffman, LM, Hukin, J, Lucas, JT, Mueller, S, Navalkele, P, Ronsley, R, Tinkle, C, Villeneuve, S, Yeo, KK, Su, JM, Margol, A, Gottardo, NG, Allen, J, Packer, R, Bartels, U & Abdelbaki, MS 2021, 'Multi-institutional analysis of treatment modalities in basal ganglia and thalamic germinoma', Pediatric Blood and Cancer, vol. 68, no. 10, e29172. https://doi.org/10.1002/pbc.29172

TY - JOUR

T1 - Multi-institutional analysis of treatment modalities in basal ganglia and thalamic germinoma

AU - Graham, Richard T.

AU - Abu-Arja, Mohammad H.

AU - Stanek, Joseph R.

AU - Cappellano, Andrea

AU - Coleman, Christina

AU - Chi, Susan

AU - Cooney, Tabitha

AU - Dhall, Girish

AU - Ellen, Jacob G.

AU - Finlay, Jonathan L.

AU - Fisher, Michael J.

AU - Friedman, Gregory K.

AU - Gajjar, Amar

AU - Gauvain, Karen

AU - Hoffman, Lindsey M.

AU - Hukin, Juliette

AU - Lucas, John T.

AU - Mueller, Sabine

AU - Navalkele, Pournima

AU - Ronsley, Rebecca

AU - Tinkle, Christopher

AU - Villeneuve, Stephanie

AU - Yeo, Kee Kiat

AU - Su, Jack M.

AU - Margol, Ashley

AU - Gottardo, Nicholas G.

AU - Allen, Jeffrey

AU - Packer, Roger

AU - Bartels, Ute

AU - Abdelbaki, Mohamed S.

PY - 2021/10

Y1 - 2021/10

N2 - Background: Central nervous system (CNS) germinomas are treatment-sensitive tumors with excellent survival outcomes. Current treatment strategies combine chemotherapy with radiotherapy (RT) in order to reduce the field and dose of RT. Germinomas originating in the basal ganglia/thalamus (BGTGs) have proven challenging to treat given their rarity and poorly defined imaging characteristics. Craniospinal (CSI), whole brain (WBI), whole ventricle (WVI), and focal RT have all been utilized; however, the best treatment strategy remains unclear. Methods: Retrospective multi-institutional analysis has been conducted across 18 institutions in four countries. Results: For 43 cases of nonmetastatic BGTGs, the 5- and 10-year event-free survivals (EFS) were 85.8% and 81.0%, respectively, while the 5- and 10-year overall survivals (OS) were 100% and 95.5%, respectively (one patient fatality from unrelated cause). Median RT doses were as follows: CSI: 2250 cGy/cGy(RBE) (1980–2400); WBI: 2340 cGy/cGy(RBE) (1800–3000); WVI: 2340 cGy/cGy(RBE) (1800–2550); focal: 3600 cGy (3060–5400). Thirty-eight patients (90.5%) received chemotherapy. There was no statistically significant difference in the EFS based on initial field extent (p =.84). Nevertheless, no relapses were reported in patients who received CSI or WBI. Chemotherapy alone had significantly inferior EFS compared to combined therapy (p =.0092), but patients were salvageable with RT. Conclusion: Patients with BGTGs have excellent outcomes and RT proved to be an integral component of the treatment plan. This group of patients should be included in future prospective clinical trials and the best RT field should be investigated further.

AB - Background: Central nervous system (CNS) germinomas are treatment-sensitive tumors with excellent survival outcomes. Current treatment strategies combine chemotherapy with radiotherapy (RT) in order to reduce the field and dose of RT. Germinomas originating in the basal ganglia/thalamus (BGTGs) have proven challenging to treat given their rarity and poorly defined imaging characteristics. Craniospinal (CSI), whole brain (WBI), whole ventricle (WVI), and focal RT have all been utilized; however, the best treatment strategy remains unclear. Methods: Retrospective multi-institutional analysis has been conducted across 18 institutions in four countries. Results: For 43 cases of nonmetastatic BGTGs, the 5- and 10-year event-free survivals (EFS) were 85.8% and 81.0%, respectively, while the 5- and 10-year overall survivals (OS) were 100% and 95.5%, respectively (one patient fatality from unrelated cause). Median RT doses were as follows: CSI: 2250 cGy/cGy(RBE) (1980–2400); WBI: 2340 cGy/cGy(RBE) (1800–3000); WVI: 2340 cGy/cGy(RBE) (1800–2550); focal: 3600 cGy (3060–5400). Thirty-eight patients (90.5%) received chemotherapy. There was no statistically significant difference in the EFS based on initial field extent (p =.84). Nevertheless, no relapses were reported in patients who received CSI or WBI. Chemotherapy alone had significantly inferior EFS compared to combined therapy (p =.0092), but patients were salvageable with RT. Conclusion: Patients with BGTGs have excellent outcomes and RT proved to be an integral component of the treatment plan. This group of patients should be included in future prospective clinical trials and the best RT field should be investigated further.

KW - basal ganglia

KW - chemotherapy

KW - germinoma

KW - pure germinoma

KW - radiation therapy

KW - thalamus

UR - http://www.scopus.com/inward/record.url?scp=85107739177&partnerID=8YFLogxK

U2 - 10.1002/pbc.29172

DO - 10.1002/pbc.29172

M3 - Article

C2 - 34125480

AN - SCOPUS:85107739177

SN - 1545-5009

VL - 68

JO - Pediatric Blood and Cancer

JF - Pediatric Blood and Cancer

IS - 10

M1 - e29172

ER -

Multi-institutional analysis of treatment modalities in basal ganglia and thalamic germinoma

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Keywords

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