All issues > Volume 48(2); 2005

Original Article

Korean J Pediatr. 2005;48(2):186-190. Published online February 15, 2005.

Responses and Toxicities of Risk-adapted Chemotherapy in Pediatric Intracranial Germ Cell Tumors

Dong Kil DK You¹, Soo Hyun SH Lee¹, Keon Hee KH Yoo¹, Ki Woong KW Sung¹, Do Hoon DH Lim², Hyung Jin HJ Shin³, Hong Hoe HH Koo¹

¹Department of Pediatrics, Samsung Seoul Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
²Department of Radiation Oncology, Samsung Seoul Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
³Department of Neurosurgery, Samsung Seoul Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence Hong Hoe HH Koo ,Email: hhkoo@smc.samsung.co.kr

Abstract

Purpose
: The purpose of this study was to evaluate the responses and toxicities of risk-adapted chemotherapy in pediatric intracranial germ cell tumors(IC-GCT).
Methods
: Fourteen patients who were diagnosed as IC-GCT from October 2002 to December 2003 received chemotherapy as an initial treatment modality. The low risk(LR) group was defined as follows : Pure germinoma and normal AFP level. Beta-hCG level 50 mIU/mL or less. The others belonged to the high risk(HR) group. Chemotherapy was composed of cisplatin, cyclophosphamide, etoposide and vincristine. Double doses of cisplatin and cyclophosphamide was used in HR patients.
Results
: Pathologic confirmation was done in all but one. Median age at diagnosis was 11.6 yr (1.2-18.7 yr), and nine patients belonged to the HR group. Tumor markers were normalized after chemotherapy in all patients whose tumor markers had been elevated. Four LR patients(80 percent) and seven HR patients(77.8 percent) showed complete response(CR) at the end of chemotherapy. An additional two of the three patients with partial response(PR) achieved CR after radiation therapy (RT), and the remaining one relapsed before RT. Four LR and all HR patients experienced infectious episodes that required hospitalization. Four of the nine HR patients(44.4 percent) suffered from tinnitus, three of whom developed sensorineural hearing loss. All but one are surviving, event-free, with a median follow-up of 13.9 mo(8.1-22.3 mo).
Conclusion
: Risk-adapted cisplatin-based chemotherapy was effective even in HR patients, but regimen modification seems to be necessary to avoid an unacceptably high toxicity rate.

Keywords :Intracranial germ cell tumor , Chemotherapy , Responses , Toxicities