GCT-35. SALVAGE CRANIOSPINAL IRRADIATION FOR RECURRENT GERMINOMAS

BACKGROUND: The treatment strategies for recurrence has not been established. PURPOSE: To clarify the tumor control and complications of salvage craniospinal irradiation (CSI) for recurrent germinoma. METHODS: We retrospectively reviewed the medical record. Among 153 germinomas treated in Tohoku University Hospital since 1983, 22 had recurrence of germinoma. At first recurrence, 7 cases received CSI, whereas 15 cases did chemotherapy and/or radiation therapy other than craniospinal field (non- CSI). CSI was performed at 24 Gy/ 12 fractions or 30 Gy/ 25 fractions. RESULTS: CSI had statistically significant better recurrence-free survival rate after recurrence than non-CSI (100% vs 33%, p<0.001: log-rank test). In addition, tumor control was obtained in all of four cases with the failure after non- CSI treatments for recurrence. The late complications of these 11 cases were examined. The local dose before CSI was 24- 50 Gy, and the median interval from last irradiation to CSI was 33 months. Median follow- up period after CSI was 126 months. Three patients developed newly developed visual or cognitive deficits. These patients received high-dose irradiation at initial treatment or multiple treatment before CSI. There were no late complications in the cases which had prior chemotherapy and 24 Gy of irradiation to whole ventricle only before CSI. CONCLUSION: Low dose CSI for the first recurrence of germinoma is effective and safe in the cases treated by chemotherapy and low dose irradiation to whole ventricle only.