A Multi-Centre Clinical Trial of CNS Germ Cell Tumours in Hong Kong

Abstract

METHOD: This clinical trial started from January 2008 and ended in June 2014. Patients who were suspected to have germinoma received a biopsy, followed by chemotherapy with carboplatin (600 mg per m2 on day 1) and etoposide (150 mg per m2 per day, day 1 to 3), alternating with ifosfamide (1.8 mg per m2 per day and etoposide 150 mg per m2 per day, day 1 to 5). They were assessed with MRI every 2 cycles. A total of 4 cycles of chemotherapy were given, followed by radiotherapy. The dose and volume of radiotherapy depend on the response and site of involvement. Patients with non-germinomatous germ cell tumours received operation to remove the tumour (if possible), chemotherapy as above for 6 cycles, reassessed by MRI once in two cycles, and cranio-spinal radiotherapy. The patients may need a second look operation if necessary. RESULTS: The data were reviewed on 31 May 2017. There were 45 patients, male to female ratio: 2.8:1, median age: 12.5 years of age (0.4 to 18.7). The pathology were germinoma (n=24) and non-germinomatous germ cell tumours (n=21). The locations of the tumours were suprasellar/sellar(n=13), pineal gland (n=20), suprasellar & pineal gland (n=7) and basal ganglia (n=4) and left frontal lobe (n=1). Five patients had metastatic diseases at presentation. Two patient had relapses. The median follow-up time was 6.75 years (2.43 to 9.54). PFS and OS at 5 years were 95.5% and 100% respectively. CONCLUSION: With a multidisciplinary approach, a satisfactory outcome is achieved.