Treatment and survival of primary intracranial germ cell tumors: a population-based study using SEER database

  • Steven Denyer
  • Abhiraj D. Bhimani
  • Shashank N. Patil
  • Andrew Mudreac
  • Mandana Behbahani
  • Ankit I. MehtaEmail author
Original Article – Clinical Oncology



Primary intracranial germ cell tumors are rare neoplasms derived from gonadal cells. They are categorized as germinoma, non-germinomatous germ cell tumor (NGCCT), or teratoma, with the latter two sparking controversy regarding the role of different treatment strategies. We provide the largest multicenter analysis of treatment outcomes for iGCTs to date.


The Surveillance, Epidemiology, and End Result (SEER) database were used to record patient demographics, tumor, and treatment characteristics. Cox proportional hazards model and multiple comparisons for the Logrank test with Sidak correction was applied to compare the different treatment regimens and survival.


1043 iGCT cases were divided into three cohorts of Germinoma, Malignant Teratoma (MT), and NGGCT. The mean age was 17.7 years for germinoma, 9.5 years for MT, and 14.4 years for NGGCT groups. Males comprised 77% of overall patient population. For Germinomas, both biopsy (hazard ratio [HR] = 4.6) and resection (HR = 14.1) had significantly worse survival outcomes compared to solo radiation therapy, with no difference between radiation and chemotherapy. For MT, no treatment combination had significantly different survival outcomes compared to resection alone. For NGGCTs, resection + chemotherapy + radiotherapy (HR = 0.012) and resection + chemotherapy (HR = 0.0049) had significantly better survival compared to resection alone.


In germinomas, radiotherapy alone had superior survival outcomes compared to biopsy and resection, but no change in survival when compared to chemotherapy alone. Addition of radiotherapy or chemotherapy did not improve survival in MTs when compared to resection alone. Adding chemotherapy in NGGCT patients undergoing resection improved survival compared to resection alone.


CNS Germ cell tumors Gernomina Malignant teratoma Treatment 




Author contribution

Conception and design: SD, ADB, AIM; collection and assembly of data: SD, SNP, AM; data analysis and interpretation: SD, ADB, MB; manuscript writing: SD, ADB, SNP, AM; critical review of the manuscript: MB, AIM; final approval of manuscript: All authors.


The authors have not received any funding for this work.

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Supplementary material

432_2019_3088_MOESM1_ESM.docx (28 kb)
Supplementary material 1 (DOCX 27 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversity of Illinois at Chicago College of MedicineChicagoUSA
  2. 2.Department of NeurosurgeryIcahn School of Medicine at Mount SinaiNew YorkUSA

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