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Intracranial Germ Cell Tumors

^a Center for Neuroscience and Behavioral Medicine, Department of Neurology, Children's National Medical Center; Department of Neurology and Pediatrics, The George Washington University, Washington, DC and Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA; ^b Department of Pediatric Neurology and the Brain Tumor Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA; ^c Center for Neuroscience and Behavioral Medicine, Department of Neurology, Children's National Medical Center, Washington, DC, USA

Correspondence: Roger J. Packer, M.D., Department of Neurology, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010, USA. Telephone: 202-884-2120; Fax 202-884-5226; e-mail: rpacker{at}cnmc.org

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 -fetoprotein and ß-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.

Key Words. Intracranial germ cell tumor • Germinoma • Mixed germ cell tumor • Nongerminomatous germ cell tumor • Chemotherapy • Radiation therapy • Embryonal carcinoma • Teratoma

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