LINC-04. POSSIBLE ROLE OF NEOADJUVANT CHEMOTHERAPY IN METASTATIC PURE GERMINOMA IN LOW AND MIDDLE INCOME COUNTRIES. A PRO POS OF A CASE

BACKGROUND: CNS germ cell tumors represent about 3–5 % of pediatric brain tumors, 60% are pure germinomas. Germinomas are very sensitive to chemotherapy which has helped to reduce volume and dose of radiotherapy in localized disease while maintaining excellent survival. In metastatic disease the SIOP GCT-96 trial showed no benefit with addition of chemotherapy to craniospinal irradiation alone. Radiotherapy maybe not readily available in Low/Middle Income Countries (LMIC). METHOD: We describe a patient in which the use of neoadjuvant chemotherapy helped to rescue vision. The patient is a 9 year old female with a 3 months history of morning headaches and vomits. Visual decline was noticed a month before admission when the child had completely loss vision of the right eye and left eye was partially affected. MRI showed a large suprasellar mass with ventricular nodules. Beta-hGC in CSF was mildly elevated. Patient received 2 cycles of carboplatin/etoposide. After first cycle there was a complete vision recovery in both eyes. After the second course the MRI showed complete response in primary and metastatic disease. Patient received CSI (24Gy + 16 Gy Boost) after 2 cycles of chemotherapy. Chemotherapy was very well tolerated without side effects. Patient vision is 20/20 in both eyes without deficit in visual fields. CONCLUSION: Although the addition of chemotherapy in metastatic germinoma has no clear role in reducing radiotherapy it could possible help selected patients in attempt to rescue vision when radiotherapy is not readily available.