ID #951 Chemoradiotherapy for pediatric pure intracranial germinoma in Vietnam: a retrospective study of 30 pathologically confirmed cases

Background

Limited radiotherapy (RT) capacity can delay treatment for curable pediatric brain tumors. At Children’s Hospital 2 (Vietnam), RT waiting times were around 2 months. Therefore, an upfront induction chemotherapy pathway followed by risk-adapted RT was adopted in 2021 to bridge RT access.This study describes the clinical characteristics and early outcomes of children treated using this approach.

Methods

We retrospectively reviewed consecutive patients aged <18 years with pathologically confirmed pure intracranial germinoma treated between January 2021 and December 2025 (n = 30). All patients had non-secreting tumor markers in serum and cerebrospinal fluid (AFP ≤25 ng/mL; β-hCG ≤50 IU/L). Localized disease received four induction chemotherapy cycles based on SIOP recommendations, alternating Carboplatin/Etoposide and Ifosfamide/Etoposide, followed by risk-adapted RT (24 Gy whole-ventricle irradiation with a boost for partial response). Metastatic disease was treated with craniospinal irradiation per protocol. Selected cases underwent multidisciplinary review with international expert consultation. Overall survival (OS) and progression-free survival (PFS) were estimated using Kaplan–Meier methods. Median follow-up was 31.2 months (range 1.8–57.4).

Results

Median age at diagnosis was 12.0 years (range 0.4–15.7), with a male-to-female ratio of 2.3:1. Metastatic disease was present in 16.7% (5/30). Primary tumor locations were suprasellar (46.7%) and pineal (30.0%). Diabetes insipidus (50.0%) and hydrocephalus (26.7%) were common clinical presentations. RT or craniospinal irradiation was delivered in 25/30 patients (83.3%). Five patients did not proceed to RT due to chemotherapy-related neutropenic sepsis (n = 2), COVID-19–related treatment disruption (n = 1), family refusal after complete response (n = 1), or age <2 years (n = 1). At last follow-up, 27/30 patients (90.0%) were alive; three deaths occurred (sepsis, n = 2; COVID-19–related disruption, n = 1). Kaplan–Meier estimated 3-year OS was 87.5% and 3-year PFS was 82.9%. Two recurrences were reported and subsequently classified as mixed germinoma and immature teratoma on pathology review.

Conclusions

Early outcomes were comparable to international reports. An upfront chemotherapy and risk-adapted RT pathway, adapted from SIOP-based recommendations, is feasible for bridging RT delays in resource-constrained settings. Infection-related mortality underscores the need for strengthened supportive care. Long-term endocrine, neurological, and neuropsychological follow-up is essential to characterize late effects and optimize survivorship.

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