ACNS1123
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.
Overview
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.
In 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.
- 87.8 out of 100 people alive without the cancer growing at 3 years with Chemotherapy then 30.6 Gy whole-ventricular irradiation with boost.
- This is a surrogate endpoint: it measures the cancer being controlled or absent on scans and tests, which often, but not always, translates into living longer.
- 86.5 out of 100 people alive without the cancer growing at 3 years with Carboplatin and etoposide then response-based reduced-dose radiotherapy.
- This is a surrogate endpoint: it measures the cancer being controlled or absent on scans and tests, which often, but not always, translates into living longer.
- 92.4 out of 100 people alive at 3 years with Chemotherapy then 30.6 Gy whole-ventricular irradiation with boost.
- Overall survival counts deaths from any cause, so it is the most direct measure of whether a treatment helps people live longer.
- 83.3 out of 100 people alive without the cancer growing at 3 years with Chemotherapy then reduced whole-ventricular irradiation.
- This is a surrogate endpoint: it measures the cancer being controlled or absent on scans and tests, which often, but not always, translates into living longer.
- There was no comparison group, so this number cannot tell you how much of the effect is due to the treatment.
- These results apply to the people the trial enrolled: 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. People in a different situation may not see the same effect.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
262 enrolled.
Standard error 4.04; 92 percent in ACNS0122 with craniospinal irradiation
Source95% CI 76.55 to 93.32
Source95% CI 72.13 to 91.38
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Progression-free survival at 3 years, non-germinomatous germ cell tumours given reduced radiotherapy after chemotherapy responseprimary | Chemotherapy then 30.6 Gy whole-ventricular irradiation with boost | 66 | 87.8% | - | - | link |
| Overall survival at 3 years, non-germinomatous stratum | Chemotherapy then 30.6 Gy whole-ventricular irradiation with boost | 66 | 92.4% | - | - | link |
| Progression-free survival at 3 years, localised germinoma given reduced-dose radiotherapy (registry results)primary | Carboplatin and etoposide then response-based reduced-dose radiotherapy | - | 86.49% | - | - | link |
| Progression-free survival at 3 years, non-germinomatous stratum (registry results, all treated) | Chemotherapy then reduced whole-ventricular irradiation | - | 83.33% | - | - | link |
Similar pages
not linked directly; found by shared links- TrialACNS0122
Shares ACNS1123: response-based reduced radiotherapy for localised CNS non-germinomatous germ cell tumours, Central nervous system germ cell tumours (germinoma and non-germinomatous), Ifosfamide, Childhood cancers (all types) and the tag soc-trials.
- TrialACNS0121
Shares Childhood cancers (all types), Brain and spinal cord tumours (all types), Children's Oncology Group (COG), Etoposide and the tag soc-trials.
- TrialAGCT1531
Shares Germ cell tumours of childhood and adolescence (extracranial and CNS), Childhood cancers (all types), Children's Oncology Group (COG), Etoposide and the tag soc-trials.
- TrialACNS0333
Shares Childhood cancers (all types), Brain and spinal cord tumours (all types), Children's Oncology Group (COG), Etoposide and the tag soc-trials.
- TrialACNS1422
Shares Childhood cancers (all types), Brain and spinal cord tumours (all types), Children's Oncology Group (COG), IMRT / IGRT (modern external beam) and the tag soc-trials.
- TrialAEWS0031
Shares Ifosfamide, Childhood cancers (all types), Children's Oncology Group (COG), Etoposide and the tag soc-trials.
- TrialANBL0531
Shares Childhood cancers (all types), Children's Oncology Group (COG), Etoposide, Carboplatin and the tag soc-trials.
- TrialEuroNet-PHL-C2
Shares Childhood cancers (all types), Etoposide, IMRT / IGRT (modern external beam), Cytotoxic chemotherapy and the tag soc-trials.