CNS germinoma

[Maforce]

I have a few scenarios that I hope the members of this forum may be able to help out.

1. Pt with supratentorial pure germinoma. CSF and MRI spine w/u negative. Underwent GTR with no residual. Do you:
a) WVI 24 Gy and boost the primary tumor bed to 36Gy,
b) WVI 24 Gy and boost the primary tumor bed to 45Gy, or
c) WVI 36 Gy and boost the primary tumor bed to 45Gy

2. Same pt with supratentorial pure germinoma. CSF and MRI spine w/u negative. Underwent STR with residual.
Do you:
a) WVI 24 Gy and boost the primary tumor bed to 36Gy,
b) WVI 24 Gy and boost the primary tumor bed to 45Gy, or
c) WVI 36 Gy and boost the primary tumor bed to 45Gy

2. Same pt with supratentorial pure germinoma. CSF w/u positive. Underwent STR with residual.
Do you:
a) CSI 24 Gy and boost the primary tumor bed to 36Gy,
b) CSI 24 Gy and boost the primary tumor bed to 45Gy,
c) CSI 36 Gy and boost the primary tumor bed to 45Gy,


3. Pt with CNS NSGCT. CSF and MRI spine w/u negative. Do you:
a) WVI 36 Gy and boost the primary tumor bed to 45Gy,
b) CSI 24 Gy and boost the primary tumor bed to 45Gy
c) CSI 36 Gy and boost the primary tumor bed to 45Gy

4. Pt with CNS NSGCT. CSF w/u positive. Do you:
a) CSI 24 Gy and boost the primary tumor bed to 45Gy
b) CSI 36 Gy and boost the primary tumor bed to 45Gy


Appreciate your input

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[seper]

Thanks for reminding me how rudimentary my knowledge of radiation oncology really is.

 

[Palex80]

1. A (It's evidence free, but it was a GTR, so I believe 36 Gy are sufficient in this case.)

2. B (That should work fine.)

3. C

4. B + CHEMO! (Some may even boost up to 50.4Gy)



Pure germinoma is histologically seminoma. Just not in the testes, but in the brain.
That's why I think (regardless of what doses the trials used so far), we should try to decrease the dose in the future.