October 22, 2018/Cancer/Research

Children with Localized Non-Germinomatous Germ Cell Tumors May Benefit from Reduced-Volume Radiation

Initial study results are encouraging


Early results from a phase II trial of response-based, reduced-volume radiation therapy for pediatric patients with localized non-germinomatous germ cell tumors indicate that reducing radiation volume by targeting treatment to the whole ventricle could be considered, but with a higher risk of failure, in particular within the spinal canal. Results will be presented at the 2018 ASTRO Annual Meeting in San Antonio.


Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Non-germinomatous germ cell tumors have the potential to spread anywhere cerebral spinal fluid flows. “Classically, patients with non-germinomatous germ cell tumors receive induction chemotherapy then radiation to their whole brain and spine,” says Erin Murphy, MD, Director of Pediatric Radiation Oncology at Cleveland Clinic.

Still, whole brain and spine radiation can impact a patient’s long-term quality of life, potentially adversely affecting physical growth, neuro-cognitive development and hormonal regulation, and increasing the risk of secondary cancers. “With reduced-volume radiation, we don’t see as much of those effects,” Dr. Murphy says.

Reducing radiation volume

As a co-principal investigator for clinical trial ACNS1123, Dr. Murphy and her team set out to determine if patients with non-germinomatous germ cell tumors who responded well to induction chemotherapy would also experience improved outcomes with reduced-volume radiation therapy. In the trial, pediatric patients age 3 to 21 with non-germinomatous germ cell tumors who experienced partial or complete response after induction chemotherapy received radiation limited to the whole ventricle in a dose of 36 Gy and a total boost of 54 Gy to the primary site, five days per week for six weeks.

Non-germinomatous germ cell tumors are rare. “Radiation oncologists may only treat one or two of these kids a year,” Dr. Murphy says.


For increased precision in this study, radiation oncologists across multiple institutions used an online contouring atlas to provide high-quality radiation therapy. “The online contouring axis made radiation delivery more reproducible and ensured that radiation oncologists were targeting the appropriate cerebral spinal fluid space and avoiding normal structures,” Dr. Murphy says.

The study found that at three years, progression-free survival was 88 percent and overall survival was 92 percent. Those results are being compared to a previous clinical trial performed by the Children’s Oncology Group, ACNS0122, in which pediatric patients with non-germinomatous germ cell tumors received the same induction chemotherapy, followed by radiation to the whole brain and spine, resulting in higher volume radiation. Five-year progression-free survival for ACNS0122 was 92 percent; five-year overall survival was 98 percent.

“The early survival data from ACNS1123 is encouraging, but with the caveat that longer follow-up of these patients is necessary to better inform future treatment guidelines,” Dr. Murphy says.

Focusing on failure patterns

It is particularly noteworthy that eight patients participating in ACNS1123 failed in the spinal canal, outside of the radiation field. “We found that all eight patients had distant failure in the spine, which is significant because it’s a different pattern of failure than seen in other studies,” Dr. Murphy says.


The findings suggest that the spine is a risk for recurrence when only the ventricle and primary tumor are targeted with radiation.

Overall, the results of ACNS1123 are controversial. “Some oncologists want to reduce treatment to improve the long-term quality of life for these kids. But that could be at the risk of more kids failing and requiring additional intense treatment,” says Dr. Murphy, who is in the process of developing radiation treatment guidelines for non-germinomatous germ cell tumors.

At this juncture, the guidelines will indicate that reduced-volume radiation can be considered, but with a higher risk for failure. Until more evidence is in regarding the safety of this radiation protocol, “it’s important to discuss the treatment option with a multidisciplinary oncology team when making treatment recommendations,” Dr. Murphy says.

Related Articles

Doctors working on MGUS screening study
March 18, 2024/Cancer/Research
Pilot Study Aims for Early Identification of Multiple Myeloma Precursor Among Black Patients

First-of-its-kind research investigates the viability of standard screening to reduce the burden of late-stage cancer diagnoses

Physician with patient
March 6, 2024/Cancer/Research
Targeting Uncontrolled Erythrocytosis in Polycythemia Vera with Rusfertide

Study demonstrates ability to reduce patients’ reliance on phlebotomies to stabilize hematocrit levels

Doctor measuring patient's waist size
February 26, 2024/Cancer/Research
Impact of Obesity on GVHD & Transplant Outcomes in Hematologic Malignancies

Findings highlight an association between obesity and an increased incidence of moderate-severe disease

Physician with patient
February 21, 2024/Cancer/Research
Strategies for Improving Clinical Trial Equity

Cleveland Clinic Cancer Institute takes multi-faceted approach to increasing clinical trial access

How antibody drug conjugates work
February 13, 2024/Cancer/Research
Real-World Use of Trastuzumab Deruxtecan

Key learnings from DESTINY trials

February 1, 2024/Cancer/Research
Possibilities of CRISPR Technology (Podcast)

Gene editing technology offers promise for treating multiple myeloma and other hematologic malignancies, as well as solid tumors

Disparities in multiple myeloma
January 25, 2024/Cancer/Research
Major Study Identifies Global Disparities in Drug Toxicity for Multiple Myeloma Treatment

Study of 401,576 patients reveals differences in cancer burdens as well as overall survival

Dr. Shilpa Gupta
December 27, 2023/Cancer/Research
A New Standard Emerges in Advanced Urothelial Carcinoma After Decades of First-Line Chemotherapy

Enfortumab plus pembrolizumab reduced risk of death by 53% compared with platinum-based chemotherapy