Radiation Therapy Compared With Chemotherapy and Radiation Therapy in Treating Patients With Newly Diagnosed Primary Central Nervous System (CNS) Germ Cell Tumor
Brain Tumor, Central Nervous System Tumor
About this trial
This is an interventional treatment trial for Brain Tumor focused on measuring childhood central nervous system germ cell tumor
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically confirmed primary CNS pure germ cell tumor Diagnosed within the past 31 days Meets any 1 OR none (i.e., M0 [localized disease]) of the following staging criteria: M+ (disseminated disease) Leptomeningeal or intraventricular metastases visualized on MRI scans of the brain and spine Clumps of tumor cells on lumbar cerebrospinal fluid (CSF) cytology Visible tumor studding the walls of the lateral or third ventricles noted during endoscopy or surgery Primary tumor arising within the parenchyma of the brain, brainstem, or spinal cord Measurable multi-focal tumors arising in both the pineal and suprasellar regions (i.e., multiple midline tumors) Infiltrative, intra-axial extension on brain MRI > 1 cm beyond enhancing tumor Modified M+ (occult multi-focal disease) M0 at diagnosis with a localized pineal region tumor with signs and symptoms of diabetes insipidus without measurable disease in the suprasellar region Lumbar CSF assay meeting criteria for the following marker profiles: Serum and CSF beta human chorionic gonadotropin (β-HCG) ≤ 50 IU/dL Serum alpha fetoprotein (AFP) ≤ 10 IU/L AND ≤ institutional norm CSF AFP ≤ 2.0 IU/L AND ≤ institutional norm PATIENT CHARACTERISTICS: Age 3 to 25 Performance status Not specified Life expectancy Not specified Hematopoietic Absolute neutrophil count > 1,000/mm^3 Platelet count > 100,000/mm^3 (transfusion independent) Hemoglobin > 10.0 g/dL (transfusion allowed) Hepatic Bilirubin ≤ 1.5 times upper limit of normal (ULN) aspartate aminotransferase (AST) or alanine aminotransferase (ALT) < 2.5 times ULN Renal Creatinine adjusted according to age as follows*: No greater than 0.4 mg/dL (≤ 5 months) No greater than 0.5 mg/dL (6 months -11 months) No greater than 0.6 mg/dL (1 year-23 months) No greater than 0.8 mg/dL (2 years-5 years) No greater than 1.0 mg/dL (6 years-9 years) No greater than 1.2 mg/dL (10 years-12 years) No greater than 1.4 mg/dL (13 years and over [female]) No greater than 1.5 mg/dL (13 years to 15 years [male]) No greater than 1.7 mg/dL (16 years and over [male]) AND Creatinine clearance OR radioisotope glomerular filtration rate > 70 mL/min Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception Euthyroid (with or without levothyroxine sodium therapy) as determined by normal T4 ± thyroid-stimulating hormone levels* Diabetes insipidus allowed provided patient is relatively stable on desmopressin acetate Normal endogenous cortisol function* Adequate antidiuretic hormone reserves* NOTE: *Unless receiving replacement therapy PRIOR CONCURRENT THERAPY: Biologic therapy Not specified Chemotherapy Not specified Endocrine therapy Concurrent replacement hormones allowed (e.g., corticosteroids, levothyroxine sodium, and desmopressin acetate) Radiotherapy Not specified Surgery Prior surgery for germ cell tumor allowed Other No other prior therapy for germ cell tumor Concurrent anticonvulsants allowed
Sites / Locations
- Lurleen Wallace Comprehensive Cancer at University of Alabama - Birmingham
- Phoenix Children's Hospital
- Arkansas Cancer Research Center at University of Arkansas for Medical Sciences
- Southern California Permanente Medical Group
- Loma Linda University Cancer Institute at Loma Linda University Medical Center
- Jonathan Jaques Children's Cancer Center at Miller Children's Hospital
- Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center
- Children's Hospital Central California
- Sutter Cancer Center
- Stanford Cancer Center
- Children's Hospital Center for Cancer and Blood Disorders
- Carole and Ray Neag Comprehensive Cancer Center at the University of Connecticut Health Center
- Alfred I. duPont Hospital for Children
- Children's National Medical Center
- Walter Reed Army Medical Center
- Lee Cancer Care of Lee Memorial Health System
- Nemours Children's Clinic
- University of Miami Sylvester Comprehensive Cancer Center - Miami
- Miami Children's Hospital
- Florida Hospital Cancer Institute at Florida Hospital Orlando
- Sacred Heart Cancer Center at Sacred Heart Hospital
- All Children's Hospital
- St. Joseph's Cancer Institute at St. Joseph's Hospital
- Winship Cancer Institute of Emory University
- Mountain States Tumor Institute at St. Luke's Regional Medical Center
- Children's Memorial Hospital - Chicago
- University of Chicago Cancer Research Center
- Advocate Christ Medical Center
- Lucille P. Markey Cancer Center at University of Kentucky
- Kosair Children's Hospital
- Tulane Cancer Center Office of Clinical Research
- CancerCare of Maine at Eastern Maine Medical Center
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
- Floating Hospital for Children at Tufts - New England Medical Center
- Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute
- C.S. Mott Children's Hospital at University of Michigan Medical Center
- Barbara Ann Karmanos Cancer Institute
- Butterworth Hospital at Spectrum Health
- CCOP - Kalamazoo
- Children's Hospitals and Clinics of Minnesota - Minneapolis
- Mayo Clinic Cancer Center
- University of Mississippi Cancer Clinic
- Ellis Fischel Cancer Center at University of Missouri - Columbia
- Children's Mercy Hospital
- Cardinal Glennon Children's Hospital
- Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis
- CCOP - Nevada Cancer Research Foundation
- Overlook Hospital
- Saint Peter's University Hospital
- Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School
- Newark Beth Israel Medical Center
- St. Joseph's Hospital and Medical Center
- University of New Mexico Cancer Center
- Albert Einstein Cancer Center at Albert Einstein College of Medicine
- Maimonides Cancer Center at Maimonides Medical Center
- Roswell Park Cancer Institute
- NYU Cancer Institute at New York University Medical Center
- Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center
- Memorial Sloan-Kettering Cancer Center
- James P. Wilmot Cancer Center at University of Rochester Medical Center
- Stony Brook University Cancer Center
- Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill
- Blumenthal Cancer Center at Carolinas Medical Center
- Akron Children's Hospital
- Cincinnati Children's Hospital Medical Center
- Rainbow Babies and Children's Hospital
- Cleveland Clinic Taussig Cancer Center
- Children's Medical Center - Dayton
- Oklahoma University Cancer Institute
- Legacy Emanuel Hospital and Health Center and Children's Hospital
- Penn State Cancer Institute at Milton S. Hershey Medical Center
- Children's Hospital of Philadelphia
- St. Christopher's Hospital for Children
- Children's Hospital of Pittsburgh
- Rhode Island Hospital Comprehensive Cancer Center
- Hollings Cancer Center at Medical University of South Carolina
- Palmetto Health South Carolina Cancer Center
- Greenville Hospital Cancer Center
- Sanford Cancer Center at Sanford USD Medical Center
- East Tennessee Children's Hospital
- St. Jude Children's Research Hospital
- Texas Tech University Health Sciences Center School of Medicine - Amarillo
- Dell Children's Medical Center of Central Texas
- Driscoll Children's Hospital
- Simmons Comprehensive Cancer Center at University of Texas Southwestern Medical Center - Dallas
- Cook Children's Medical Center - Fort Worth
- Baylor University Medical Center - Houston
- M. D. Anderson Cancer Center at University of Texas
- University of Texas Health Science Center at San Antonio
- Methodist Children's Hospital of South Texas
- Primary Children's Medical Center
- Children's Hospital and Regional Medical Center - Seattle
- West Virginia University Health Sciences Center - Charleston
- Marshfield Clinic - Marshfield Center
- Midwest Children's Cancer Center at Children's Hospital of Wisconsin
- Royal Children's Hospital
- Royal Children's Hospital
- Princess Margaret Hospital for Children
- University of Alberta Hospital
- Children's & Women's Hospital of British Columbia
- CancerCare Manitoba
- Janeway Children's Health and Rehabilitation Centre
- McMaster Children's Hospital at Hamilton Health Sciences
- Children's Hospital of Eastern Ontario
- Hospital for Sick Children
- Hopital Sainte Justine
- San Jorge Children's Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
Experimental
Regimen A (radiotherapy only)
Regimen B (chemotherapy plus radiotherapy)
Within 52 days of surgery, patients will undergo standard-dose radiation therapy 5 days a week for approximately 5-6 weeks.
Courses 1 and 2: Patients receive carboplatin IV over 1 hour on days 1 and 2 and etoposide IV over 2 hours on days 1-3. Treatment repeats every 21 days for 2 courses. Within 3 weeks of completing chemotherapy, patients with CR undergo low-dose radiation therapy 5 days a week for 5 weeks. Patients with MRD, a PR, or SD receive chemotherapy courses 3 and 4 as outlined below. Courses 3 and 4: Patients receive cisplatin IV over 6 hours on day 1, cyclophosphamide IV over 1 hour on days 2 and 3, and filgrastim (G-CSF), subcutaneous (SC) or IV beginning on day 4 and continuing until blood counts recover. Treatment repeats every 21 days for 2 courses. Patients achieving a CR or MRD proceed to reduced-dose radiotherapy. Patients with a PR, SD, or progressive disease (PD) are restaged and may undergo standard radiation therapy as in regimen A. Reduced-dose radiation therapy: Within 6 weeks of starting course 4, patients undergo lower-dose radiation therapy once daily on days 1-5 for 5 weeks