ArticleNeuro-oncology2026
Final report of the SIOP-CNS-GCT II protocol for germinoma: Omitting radiotherapy boost is safe in localized disease in complete remission after chemotherapy.
Article in Neuro-oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundFor localized germinoma, whole-ventricular radiotherapy (WVRT) is standard-of-care in Europe; 24 Gray (Gy) with 16 Gy boost following chemotherapy. The SIOP-CNS-GCT-II trial aimed to examine the effect of response-adapted radiotherapy on patient outcome.
methodsPatients with localized germinoma received 4 courses of "carboPEI" chemotherapy, then 24 Gy WVRT if in complete remission (CR), with an additional 16 Gy tumor boost if residual disease was present. Metastatic cases received 24 Gy craniospinal radiotherapy (CSRT) with 16 Gy boost to all sites.
resultsBetween 2012 and 2018, 227 fully-staged germinoma patients were treated according to protocol. Five-year event-free (EFS) and overall survival (OS) for 166 localized germinoma were 0.94 ± 0.02 and 0.98 ± 0.01, respectively. Sixty-five of 166 (39.2%) were in CR after chemotherapy, of whom 64/65 received 24 Gy WVRT, only 2 of whom (2/64; 3.1%) relapsed. Of 90/166 patients in partial remission (PR) after chemotherapy, 88/90 received 24 Gy WVRT + 16 Gy; 2 relapsed (2/88; 2.3%). Of the 11 remaining patients, 8 had stable disease (SD) after chemotherapy; 7/8 received 24 Gy WVRT + 16 Gy boost and 1 received 24 Gy WVRT + 30 Gy boost because of a teratoma component; none relapsed. Three remaining patients with progressive disease (PD) during chemotherapy had variable treatments, due to differing histologies and disease spread; 1 relapsed. Five-year EFS and OS for 61 metastatic germinoma were 0.98 ± 0.02 and 1.00 ± 0.00, respectively, with 55/61 (90.2%) in CR and 5/61 (11.5%) in PR after 24 Gy CSRT + 16 Gy; 1 relapsed.
conclusionsResponse-adapted radiotherapy for localized germinoma led to excellent survival outcomes. Further treatment de-escalation should be considered in future strategies to reduce treatment burden and late effects.
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