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Germ Cell Tumors

  • Kenneth Wong
  • Chenue Abongwa
  • Eric L. Chang
  • Girish Dhall
Chapter

Abstract

Intracranial germ cell tumors (IGCTs) are rare and are most common in childhood. These tumors most often occur in the pineal gland or suprasellar region. Overall, there is a male predominance, which is more pronounced for pineal gland tumors. In the past, these tumors were thought to be more common in East Asia, but more recent studies of larger databases suggest that the incidence is very similar in the United States and Japan. There are two groups, germinomas and non-germinomatous germ cell tumors. Histological subtype is an important factor for stratification of prognosis and treatment. Recent molecular studies are shedding light on genes that may be involved in tumorigenesis. Germinomas are more common and can be cured with radiation therapy alone. For localized disease, fields have decreased from craniospinal irradiation to whole brain or whole ventricular fields. Further reduction to focal irradiation fields have resulted in an increase of intraventricular failure. Combination of irradiation with chemotherapy has permitted further decreases in dose. Chemotherapy only strategies that omit irradiation have not been proven to be satisfactory. Non-germinomatous germ cell tumors have a poorer prognosis, and best results have been achieved with chemotherapy and craniospinal irradiation. The most recent Children’s Oncology Group trial has been studying smaller volumes and lower doses for those patients who respond well to neoadjuvant chemotherapy. Long-term survivors may have changes in quality of life, neurocognition, and endocrine function. There is not a standard of care for recurrent germ cell tumors though high-dose chemotherapy and re-irradiation may play a role.

Keywords

Germinoma Neoplasms, germ cell and embryonal Basal ganglia Carcinogenesis Craniospinal irradiation Pineal gland Sella turcica Radiotherapy 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Kenneth Wong
    • 1
    • 2
  • Chenue Abongwa
    • 3
  • Eric L. Chang
    • 1
    • 2
    • 4
  • Girish Dhall
    • 5
    • 1
  1. 1.Department of Radiation OncologyKeck School of Medicine of USCLos AngelesUSA
  2. 2.Radiation Oncology ProgramChildren’s Center for Cancer and Blood Diseases, Children’s Hospital Los AngelesLos AngelesUSA
  3. 3.Department of PediatricsLoma Linda University School of MedicineLoma LindaUSA
  4. 4.Department of Radiation OncologyUniversity of Texas MD Anderson Cancer CenterHoustonUSA
  5. 5.Neuro-Oncology Program, Children’s Center for Cancer and Blood DiseasesChildren’s Hospital Los AngelesLos AngelesUSA

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