Online Articles: Original ArticlesOutcomes of Local Radiation and Intensified Combined Intrathecal Methotrexate and High-dose Chemotherapy for Intracranial Germ Cell TumorsYamasaki, Kai MD*; Okada, Keiko MD, PhD*; Soejima, Toshinori MD, PhD†; Kosaka, Yoshiyuki MD, PhD‡; Nagashima, Tatsuya MD, PhD§; Hara, Junichi MD, PhD*Author Information *Department of Pediatric Hematology and Oncology, Osaka City General Hospital, Osaka †Department of Radiation Oncology, Kobe Proton Center ‡Department of Hematology and Oncology §Department of Neurosurgery, Kobe Children’s Hospital, Kobe, Japan The authors declare no conflict of interest. Reprints: Kai Yamasaki, MD, Department of Pediatric Hematology and Oncology, Osaka City General Hospital, 2-13-22 Miyakozimahondori, Miyakozima-ku, Osaka 534-0021, Japan (e-mail: [email protected]). Journal of Pediatric Hematology/Oncology: October 2020 - Volume 42 - Issue 7 - p e551-e557 doi: 10.1097/MPH.0000000000001820 Buy SDC Metrics Abstract Many attempts to reduce radiation fields for intracranial germ cell tumors (iGCTs) remain unsuccessful. To assess the possibility of reduction, we analyzed registry data of 57 patients who mostly underwent local irradiation for iGCTs between 1997 and 2006. The recommended treatment for pure germinomas (PGNs) included 3 courses of cisplatin and etoposide followed by 24 Gy local irradiation. Intensified chemotherapy using a combination of cyclophosphamide and intrathecal methotrexate was recommended for human chorionic gonadotropin-producing germinomas (hCG-GNs) and nongerminomatous germ cell tumors (NGGCTs); both received 50.4 Gy local irradiation. High-dose chemotherapy was only administered for residual NGGCTs after chemoradiotherapy. Craniospinal irradiation was recommended only in metastatic cases. During the median follow-up of 114.8 months, 8 of 9 relapses from 24 PGNs occurred outside irradiation fields, with a 5-year progression-free survival (5-year PFS) of 75%±8.8%. Conversely, no recurrences occurred from 11 hCG-GNs, with a 5-year PFS of 100%. Eleven of 22 patients with NGGCTs received high-dose chemotherapy; the 5-year PFS was 81.3%±8.4%; 2 of 3 relapses occurred in the spinal cord. Thus, local irradiation for PGNs was insufficient without treatment intensification. The introduction of intensified chemotherapy improved outcomes of both patients with hCG-GNs and NGGCTs. However, the contributions of either modality remained unclear. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.