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Intracranial Germ Cell Tumors
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1985
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Mature TeratomaNeuro-oncologyWorld Health OrganizationTumoral PathologyImmature TeratomaSurgical PathologyHistopathologyBrain Tumor BiologyPathologyGynecologyExtragonadal Germ Cell TumoursNeuropathologyMedicineGliomaGerm Cell NeoplasiaTesticular TumoursSkull Base
Intracranial germ cell tumors are heterogeneous lesions affecting children and adults, with diverse subtypes that differ in prognosis; germinomas respond well to radiation (over 90% cure), while nongerminomatous tumors have poorer outcomes and diagnosis often relies on histology or tumor markers. The optimal radiation dose and volume for intracranial germ cell tumors remain unclear, with debate over whole‑brain or craniospinal irradiation for localized disease, but evidence indicates that adding chemotherapy to germinomas can allow lower radiation doses. Radiation therapy alone achieves disease control in only 40–60% of patients, whereas combining chemotherapy with radiation may improve survival rates.
Intracranial germ cell tumors are a heterogeneous group of lesions which occur in children and adults. Within the classification of intracranial germ cell tumors, there are a variety of different tumor types which carry different prognoses. The diagnosis of an intracranial germ cell tumor usually requires histological information, but a subgroup of tumors will secrete specific tumor markers, including alpha-fetoprotein and beta-human chorionic gonadotropin, which may obviate the need for surgical intervention. The management of intracranial germ cell tumors in both children and adults remains unsettled. Germinomas have a good prognosis, as over 90% of patients can be effectively treated with radiation therapy. The dose and volume of radiation therapy needed for disease control is not well established, and controversy exists concerning the need for whole brain or craniospinal radiation therapy for localized tumors. Germinomas are also chemosensitive and recent reports suggest that the dose and volume of radiation therapy required for disease control can be lessened with the addition of adjuvant chemotherapy. The outcome for patients with nongerminomatous germ cell tumors is less favorable. Radiation therapy alone will result in disease control in 40%-60% of patients. The addition of chemotherapy to radiation therapy may improve the rate of survival.