Outcomes for pediatric patients with central nervous system germ cell tumors treated with proton therapy

Purpose We assessed outcomes after proton therapy (PT) for central nervous system germinomas or non-germinomatous germ cell tumors (NGGCTs) in children.Patients and methods We identified children with germ cell tumors of the central nervous system who received proton therapy in 2006-2009 and extracted information on tumor response, treatment failures, and toxicity.Results Of the 20 identified patients (median age 12 years [range 3-16]), 9 had germinoma and 11 NGGCTs; 19 patients received three-dimensional conformal PT and 1 scanning-beam PT. Fourteen patients had craniospinal irradiation (CSI), 4 had ventricular irradiation that excluded the 4th ventricle, and 2 had whole-ventricle irradiation. All received involved-field boosts. At a median follow-up interval of 5.6 years (range, 0.3-8.2 years), 1 patient with germinoma had an out-of-field failure in the 4th ventricle and 2 with NGGCT died from disease progression after CSI. Rates of local control, progression-free survival, and overall survival at 5 years were 89%, 89%, and 100% for patients with germinoma; corresponding rates for NGGCTs were 82%, 82%, and 82%. The most common late toxicity (9 patients [45%]) was endocrinopathy.Conclusions PT for CNS germ cell tumors is associated with acceptable disease control rates and toxicity profiles.