GCT-03. TREATMENT OUTCOMES, PHYSICAL DEVELOPMENT AND QUALITY OF LIFE OF PATIENTS WITH BIFOCAL GERM CELL TUMOURS

BACKGROUND: The optimal radiation field in patients with bifocal germ cell tumours(GCTs) is controversial, especially in non-metastatic cases. Accordingly, we analysed the survival, growth, and health-related quality of life (HRQOL) data of patients with bifocal GCTs. METHODS: The data of 87 patients diagnosed with bifocal GCTs at our hospital during the last 10 years were collected. The WHO AnthroPlus software—used to monitor the growth of persons aged 5–19 years—was employed to calculate the Z-score of height (ZSOH) at diagnosis and the last follow-up. The absolute change in the ZSOH was defined as |ZSOH (last follow-up) - ZSOH (diagnosis)|. The Pediatric Quality of Life Inventory 4.0 was used to evaluate HRQOL. RESULTS: The median follow-up was 49 months (range,6–134 months). Among 49 patients with non-metastatic germinoma, those receiving cranial spinal irradiation(CSI; n=12) or whole-brain radiotherapy (WBRT; n=34) had comparable disease-free survival (DFS;p=0.54), but better DFS than those receiving focal radiotherapy(n=3;p=0.016). Furthermore, among 17 patients with non-metastatic non-germinomatous GCTs, DFS was not significantly different between those treated with CSI(n=4) and those receiving WBRT(n=13;p=0.11). Twenty-nine patients had paired ZSOH data at both diagnosis and the last follow-up. Patients receiving CSI(p=0.026) or >40Gy(p=0.048) experienced a significant decline of absolute change in the ZSOH. HRQOL analysis(n=35) did not reveal difference between patients receiving CSI and those not receiving CSI. CONCLUSIONS: Given the comparable DFS and HRQOL but negative impact on growth, CSI could be spared, especially in patients with non-metastatic bifocal germinoma.