Effectiveness of Upfront Radiotherapy in Central Nervous System Germ Cell Tumors.
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BACKGROUND AND PURPOSE: Radiotherapy (RT) is essential for curing central nervous system germ cell tumors (CNS-GCTs) except for pure mature teratoma (MT), but the optimal target volume, dose, and timing remain controversial. This study evaluated the benefit of upfront RT in CNS-GCTs. MATERIALS AND METHODS: We reviewed CNS-GCT patients under 30-year-old treated from 2015 to 2023. Patients with pure germinomas (PG) received whole-ventricular irradiation (WVI) with tumor bed (TB) boost. Patients with malignant non-germinomatous germ cell tumor (MNGGCT) received WVI or whole-brain irradiation (WBI) with TB boost, with or without craniospinal irradiation (CSI), before or after platinum-etoposide-based chemotherapy (CTX). Serum alpha-fetoprotein and human chorionic gonadotropin levels guided diagnosis when histopathology was unavailable. Patients with MT were treated surgically. The primary endpoint was 5-year event-free survival (EFS); secondary endpoints included overall survival (OS), neurocognitive outcomes, and endocrinopathy rates. RESULTS: Twenty-nine patients were analyzed: 13 PGs, 7 MNGGCTs with upfront RT, 7 MNGGCTs with upfront CTX, and 2 MTs. The median follow-up of these tumors was 6.0, 6.6, 3.7, and 10.3 years, respectively. PGs receiving upfront RT achieved 5-year EFS and OS of 100% and 100%, respectively. For MNGGCTs receiving upfront RT, 5-year EFS and OS was 85.7% and 85.7%, respectively; 1 patient died from post-treatment disease progression. MNGGCTs treated with upfront CTX had 5-year EFS and OS of 41.7% and 60.0%, respectively; 2 patients relapsed (1 died), and 1 died from treatment-related complications. Both MTs remained event-free over 6 years following surgery alone or with Gamma Knife radiosurgery. CONCLUSIONS: Upfront RT provided excellent outcomes in PGs and may eliminate the need for CTX in those achieving complete response.