ACNS1123: response-based reduced radiotherapy for localised CNS non-germinomatous germ cell tumours
Children whose non-germinomatous germ cell tumour of the brain responded to chemotherapy did well with radiotherapy limited to the ventricles rather than the whole brain and spine, but the few who relapsed all relapsed in the spine, so the smaller field carries a specific risk.
Overview
Children's Oncology Group phase 2 trial: 107 patients aged 3 to 21 with localised non-germinomatous germ cell tumours received six cycles of carboplatin, etoposide and ifosfamide; the 66 with a complete or partial response received 30.6 Gy whole-ventricular irradiation with a boost to 54 Gy instead of craniospinal irradiation.
Three-year progression-free survival was 87.8 percent and overall survival 92.4 percent, compared with 92 and 94.1 percent in ACNS0122 with full-dose craniospinal irradiation. Ten recurrences prompted early closure; on central review eight of 66 reduced-radiotherapy patients progressed, six with isolated spinal relapse and two with combined local and spinal relapse.
- 66 of 107 patients (61.7 percent) reached a complete or partial response and proceeded to reduced radiotherapy.
- Three-year progression-free survival 87.8 percent and overall survival 92.4 percent, against 92 and 94.1 percent in ACNS0122.
- All eight relapses after reduced radiotherapy involved the spine.
Whole-ventricular irradiation with a boost is a reasonable option after a good response to chemotherapy, but the spinal failure pattern shaped the next trial and keeps craniospinal irradiation as an alternative.
- Single-arm comparison with a historical trial; the stratum closed early after recurrences.
- Tumour markers did not predict progression.
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