ID #829 Meta-analysis: Comparison of treatment outcomes between two and four courses of pre-radiotherapy induction chemotherapy in germinoma.
Revathi Rajagopal, Adil Bahadirr, Diala Shetaiwi, Mohamed AbdelbakiAbstract
Background
Germinoma is extremely sensitive to chemotherapy and radiotherapy, with a 5-year overall survival (OS) rate of more than 90%. However, the data on the optimal number of pre-radiotherapy induction chemotherapy cycles that is considered an effective treatment is unknown.
Methods
A literature search was conducted using PubMed, Web of Science, and Google Scholar up to December 2025, encompassing both adult and pediatric data, with a focus on evaluating the overall outcomes of germinoma treated with various numbers of induction chemotherapies followed by radiotherapy.
Results
A total of 216 articles were identified, and only 17 articles were included in the analysis after screening. The analysis included a total of 99 patients, with a median age of 13 years. Sixty-five patients were male, 20 were female, and the gender of 14 patients was unknown. Forty-three patients received only two cycles of induction chemotherapy, three courses of induction chemotherapy were administered in 16 patients, and 37 patients were given four cycles of upfront chemotherapy. One patient received one course of chemotherapy, and two patients received five courses of chemotherapy. All patients received radiotherapy, except for one patient. The 5-year OS rates for patients who received two, three, and four courses of induction chemotherapy followed by radiotherapy, as per the institution’s guidelines, were 94.6±3.7%, 100%, and 97.3±2.7%, respectively. There were no statistically significant differences in the overall outcome within the various induction chemotherapy cycles, with a p-value of 0.707.
Conclusion
The results demonstrate that germinoma is associated with excellent outcomes, even with two courses of chemotherapy, comparable to the standard approach involving four cycles of chemotherapy. Therefore, efforts to reduce the number of induction chemotherapies to minimize the financial burden on families, especially in low- and middle-income countries, should be investigated in future trials.