10154-CS-15 Oral Etoposide Therapy for Multiply Recurrent Intracranial Germinoma

Abstract Germinomas are highly responsive to chemotherapy and radiotherapy, with favorable outcomes in most initial cases. However, repeated relapse can limit treatment options, especially when patients are no longer candidates for intensive intravenous chemotherapy due to poor general condition or prior treatment toxicity. At our institution, we have introduced oral etoposide as a palliative therapy in such situations. We retrospectively analyzed three cases of multiply relapsed central nervous system (CNS) germinoma treated with oral etoposide between 2007 and 2024. Case 1: A 13-year-old male with a neurohypophyseal germinoma underwent initial chemoradiotherapy. Nine years later, he developed multifocal intracranial recurrence. After high-dose chemotherapy and autologous stem cell transplantation, he relapsed again. Oral etoposide resulted in decreased HCG and 10 months of disease control. He died of tumor progression two years after starting etoposide. Case 2: An 18-year-old male with basal ganglia germinoma experienced multiple relapses over more than 10 years. At the time of HCG-positive recurrence, oral etoposide was started, achieving stable disease for four years before death from disease progression. Case 3: A 14-year-old male with germinoma involving the neurohypophysis and medulla relapsed in the cervical spine 10 years after initial remission. Oral etoposide was introduced after further relapse and maintained clinical and radiographic stability for four years. He died five years after etoposide initiation. These cases suggest that oral etoposide may be a feasible and well-tolerated palliative treatment for recurrent CNS germinoma, offering meaningful disease control and preservation of quality of life when aggressive treatment is no longer an option.