Treatment Option Overview for Childhood CNS Germ Cell Tumors

For children older than 3 years and adults, radiation therapy has been an important component of therapy for germinomas and NGGCTs, although the optimal dose and field of irradiation are debated.

Central nervous system (CNS) germ cell tumors (GCTs), similar to gonadal and extragonadal GCTs, have demonstrated sensitivity to chemotherapy.

Germinomas are highly chemosensitive and radiosensitive tumors. They are curable with craniospinal irradiation and local site–boost radiation therapy alone. However, the use of neoadjuvant or preirradiation chemotherapy allows reduced radiation therapy doses and volumes and, subsequently, reduced long-term radiation therapy–related effects.

In North America and Europe, patients with localized germinomas are effectively treated with whole-ventricular irradiation supplemented with tumor site–boost radiation therapy. Focal irradiation to the tumor bed, regardless of response to chemotherapy, is considered inadequate treatment.[6]

For NGGCTs, the combined use of more intensive neoadjuvant chemotherapy followed by either localized or craniospinal irradiation has resulted in improved survival rates in the last decade.[5,7,8]

Patients with bifocal intracranial GCTs limited to the suprasellar and pineal region were treated in the same manner as patients with localized, nonmetastatic tumors in studies in North America and Europe.[8]