Some principles for the treatment of central nervous system germ cell tumors

Abstract

Although the optimum treatment of intracranial germ cell tumors remains controversial, there are some basic underlying principles. 1) It is important to confirm the histological type of the tumors by biopsy or extirpation. 2) The appropriate extent of surgery for germinoma still remains to be discussed. The reliability of endoscopie biopsy should be compared with the results of the definite pathology after open biopsy or extirpation of the lesion. 3) In germinoma, it is not necessary to irradiate the whole spine. A reduced-volume radiotherapy such as whole-ventricular irradiation, plus chemotherapy should replace craniospinal radiotherapy to avoid the late sequelae of large - volume radiotherapy, such as impairment of endocrinological function or neurocognitive development. Focal irradiation would lead to an increased risk of recurrence. 4) Chemotherapy alone without irradiation is not sufficient to cure germinoma patients. 5) Neoadjuvant chemo-radiotherapy followed by complete excision of the residual tumors should be considered in patients with non-germinomatous germ cell tumors.