ACNS1123, Phase 2 Trial of Response-Based Radiation Therapy for Patients with Localized Central Nervous System Germ Cell Tumors

Stratum 1: 6 cycles of induction chemotherapy (cycle a - carboplatin/etoposide alternating with cycle B- ifosfamide/etoposide) if CR or PR is observed, then patient will receive radiation therapy: 30.6 Gy WVi + 23.4 Gy boost to primary tumor site. if progressive disease (PD) is observed with normal tumor markers, second-look surgery will be strongly recommended to assess CR/PR. if the patient shows evidence of CR or PR after the second-look surgery, they will then receive radiation therapy: 30.6 Gy WVi + 23.4 Gy boost to primary tumor site. if PD with increasing or positive markers is observed, or if the second-look surgery is not performed, the patient will be off protocol therapy. Stratum 2: 4 cycles of induction chemotherapy (cycle a - carboplatin/etopside) if CR or CCR is observed with normal tumor markers, patient will receive radiation therapy: 18Gy WVi + 12 Gy boost to primary site. Germinoma patients with PR, SD with [Greater Than] 1.5 cm residual and PD with normalization of hCG should be considered for second look surgery. if histology confirms mature teratoma or non-viable tumor, WVi to 18 Gy followed by local boost of 12 Gy to a total dose of 30 Gy will be delivered. Patients with [Greater Than] 0.5 cm (suprasellar) or [Greater Than] 1 cm (pineal) but less than or equal to 1.5 cm residual who do not undergo second-look surgery will be treated with WVi to 24 Gy followed by local boost of 12 Gy to a total dose of 36 Gy. if second-look surgery is not performed and patients do not meet criteria for at least PR with less than or equal to 1.5cm residual disease, patients will be off protocol therapy.