Intracranial Germinoma: Systemic Chemotherapy in Addition to Dose-Reduced Radiation Therapy
Serum tumor markers revealed an elevated lactate dehydrogenase (1359 U/L; normal range 313–618 U/L) and normal alpha-fetoprotein and beta-human chorionic gonadotropin levels. Alpha-fetoprotein and beta-human chorionic gonadotropin were also negative in the cerebrospinal fluid.
He received steroids with intermittent tapering doses. During the treatment, he received systemic chemotherapy with carboplatin-etoposide for 4 cycles with a complete response on MRI, followed by craniospinal irradiation (CSI) with 30 Gy with a boost to the primary tumor at a dose of 24 Gy.
The patient tolerated treatment well, with the exceptions of prolonged pancytopenia with 1 episode of febrile neutropenia, as well as mild facial swelling, grade 2 diarrhea, and grade 2 fatigue. His pancytopenia resolved after 2 months and repeat MRI of the brain showed a partial remission.