{"entity":{"id":"acns1123","kind":"trial","name":"ACNS1123","aka":["COG ACNS1123"],"tldr":"ACNS1123 asked whether children with germ cell tumours of the brain who respond well to chemotherapy can safely have less radiotherapy; for non-germinomatous tumours survival stayed high but the few relapses were all in the spine, which was left out of the smaller field, and for germinoma the reduced doses held.","summary":"ACNS1123 was a Children's Oncology Group phase 2 trial with two strata. Patients with localised non-germinomatous germ cell tumours received six cycles of carboplatin, etoposide and ifosfamide and, if they reached a complete or partial response (with second-look surgery where needed), reduced-dose whole-ventricular irradiation of 30.6 Gy with a boost to 54 Gy instead of the 36 Gy craniospinal irradiation used in the predecessor ACNS0122. Patients with localised germinoma received carboplatin and etoposide followed by response-adapted reduced-dose radiotherapy. Neurocognitive outcomes were measured alongside.\n\nIn the non-germinomatous stratum 66 of 107 patients qualified for reduced radiotherapy; their three-year progression-free survival was 87.8 percent and overall survival 92.4 percent, similar to ACNS0122, but ten recurrences prompted early closure of the stratum and every relapse involved the spine. The germinoma stratum had three-year progression-free survival of 86.5 percent in the registry results. The trial is the basis for whole-ventricular irradiation with a tumour boost after chemotherapy for non-germinomatous tumours, with craniospinal irradiation kept as an alternative, which is how the corpus's germ cell tumour pages cite it.","status":"completed","asOf":"2026-09-22","links":[{"label":"ClinicalTrials.gov NCT01602666","url":"https://clinicaltrials.gov/study/NCT01602666"}],"tags":["soc-trials"],"related":[],"cancers":["cns-germ-cell-tumours","paediatric-germ-cell-tumours","brain-tumours","childhood-cancers"],"sections":[],"technologies":["imrt-igrt","cytotoxic-chemotherapy"],"targets":[],"drugs":["carboplatin","etoposide","ifosfamide"],"companies":[],"institutions":["childrens-oncology-group"],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-acns1123-nggct-reduced-radiotherapy-fangusaro-jco-2019"],"journals":[],"dependsOn":[],"notes":[],"nct":"NCT01602666","phase":"2","setting":"Localised central nervous system germ cell tumours in children and young adults: induction chemotherapy (carboplatin, etoposide, ifosfamide) followed by reduced-dose, response-based radiotherapy, whole-ventricular with a tumour boost for non-germinomatous tumours and reduced-dose radiotherapy for germinoma","sponsor":"Children's Oncology Group","result":"Three-year progression-free survival 87.8 percent and overall survival 92.4 percent for non-germinomatous tumours given reduced whole-ventricular radiotherapy after a response to chemotherapy, with all relapses in the spine; three-year progression-free survival 86.5 percent for germinoma.","yearReported":2019,"enrolled":262,"enrolledBasis":"registry","outcomes":[{"endpoint":"Progression-free survival at 3 years, non-germinomatous germ cell tumours given reduced radiotherapy after chemotherapy response","primary":true,"unit":"%","arms":[{"name":"Chemotherapy then 30.6 Gy whole-ventricular irradiation with boost","n":66,"value":87.8,"note":"Standard error 4.04; 92 percent in ACNS0122 with craniospinal irradiation"}],"source":"https://doi.org/10.1200/JCO.19.00701"},{"endpoint":"Overall survival at 3 years, non-germinomatous stratum","unit":"%","arms":[{"name":"Chemotherapy then 30.6 Gy whole-ventricular irradiation with boost","n":66,"value":92.4}],"source":"https://doi.org/10.1200/JCO.19.00701"},{"endpoint":"Progression-free survival at 3 years, localised germinoma given reduced-dose radiotherapy (registry results)","primary":true,"unit":"%","arms":[{"name":"Carboplatin and etoposide then response-based reduced-dose radiotherapy","value":86.49,"note":"95% CI 76.55 to 93.32"}],"source":"https://clinicaltrials.gov/study/NCT01602666?tab=results"},{"endpoint":"Progression-free survival at 3 years, non-germinomatous stratum (registry results, all treated)","unit":"%","arms":[{"name":"Chemotherapy then reduced whole-ventricular irradiation","value":83.33,"note":"95% CI 72.13 to 91.38"}],"source":"https://clinicaltrials.gov/study/NCT01602666?tab=results"}]},"route":"/trials/acns1123/","neighbours":{"cancer":[{"id":"brain-tumours","kind":"cancer","name":"Brain and spinal cord tumours (all types)","route":"/cancers/brain-tumours/"},{"id":"cns-germ-cell-tumours","kind":"cancer","name":"Central nervous system germ cell tumours (germinoma and non-germinomatous)","route":"/cancers/cns-germ-cell-tumours/"},{"id":"childhood-cancers","kind":"cancer","name":"Childhood cancers (all types)","route":"/cancers/childhood-cancers/"},{"id":"paediatric-germ-cell-tumours","kind":"cancer","name":"Germ cell tumours of childhood and adolescence (extracranial and CNS)","route":"/cancers/paediatric-germ-cell-tumours/"}],"technology":[{"id":"cytotoxic-chemotherapy","kind":"technology","name":"Cytotoxic chemotherapy","route":"/technologies/cytotoxic-chemotherapy/"},{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"}],"drug":[{"id":"carboplatin","kind":"drug","name":"Carboplatin","route":"/drugs/carboplatin/"},{"id":"etoposide","kind":"drug","name":"Etoposide","route":"/drugs/etoposide/"},{"id":"ifosfamide","kind":"drug","name":"Ifosfamide","route":"/drugs/ifosfamide/"}],"institution":[{"id":"childrens-oncology-group","kind":"institution","name":"Children's Oncology Group (COG)","route":"/institutions/childrens-oncology-group/"}],"paper":[{"id":"paper-acns1123-nggct-reduced-radiotherapy-fangusaro-jco-2019","kind":"paper","name":"ACNS1123: response-based reduced radiotherapy for localised CNS non-germinomatous germ cell tumours","route":"/key-papers/paper-acns1123-nggct-reduced-radiotherapy-fangusaro-jco-2019/"}]}}