GERM-12. PITUITARY FAILURES IN CNS MIXED MALIGNANT GERM CELL TUMORS (MMGCTs). EXPERIENCE GENERATED IN SIOP CNS GCT 96

Abstract

CONTEXT

CNS MMGCTs are treated with a combination of chemotherapy and irradiation. In SIOP CNS GCT 96 radiotherapy (RT) doses given for local tumor control were 54 Gy. In cases with dissemination 30 Gy craniospinal RT was applied. We therefore examined the presence of pituitary failures in respect to RT dose to the pituitary region.

PATIENTS AND METHODS

We evaluated 149 patients treated between 10/96 and 31/12/2005; 86/149 patients were treated according to protocol, were alive and had no recurrence at the time of follow up in November 2009 (69 male, 17 female: mean age 14 years, observation time median 6.5 years).

RESULTS

30/86 patients had pituitary failure, of which 1 showed diabetes insipidus only, 16 had anterior pituitary failure only and 13 both. 18 of the 30 had no anterior pituitary failure at diagnosis, but only at follow-up. 10 of 86 patients had a prescription RT dose of 30 Gy and 43 had 0 Gy to the pituitary area; of these 53, 10 had pituitary failures at follow-up. 20/33 patients who received 54 Gy to the pituitary area showed anterior pituitary failure.

CONCLUSION

Pituitary failures are a major long-term risk of CNS MMGCTs. 60% of patients treated with 54 Gy prescribed RT dose to pituitary area, had anterior pituitary failure at follow-up, compared with 19% treated with 0/30 Gy. Reduction of RT dose to pituitary area where possible should be an aim of future treatment strategies for MMGCTs. (supported in part by German Cancer Aid)