GCT-21. CENTRAL NERVOUS SYSTEM GERMINOMA - PONDERING THE NEXT STEPS

Central nervous system germinoma (CNS) represents one successful example where the introduction of chemotherapy into the treatment allowed significant and meaningful reductions in the volume and dose of radiation therapy while maintaining excellent outcomes. However, the long-term toxicities and morbidities of the current therapies, in addition to their substantial negative impact on the social wellbeing of germinoma patients, should clearly indicate that the current achievements are not enough. While stepwise cutback of the radiation therapy needs to be commended, real progress must be achieved in the exploration and investigation of biological and molecular markers. Furthermore, the differences that still exist between the several working groups around the globe in determining the tumor marker cut-offs that help diagnose these tumors illustrate their shortcomings, and therefore the need for newer and more reliable methods. Additionally, efforts should focus on the inclusion of metastatic and basal ganglia/thalamic germinomas in future prospective clinical trials given the lack of evidence on the best treatment strategy for these patients. A comprehensive review of all major CNS germinoma clinical trials will be presented aiming to lay a foundation for researchers and clinicians alike who are currently working on designing innovative approaches for this group of patients. This review also details the current issues of debate, and provides suggestions which may assist in the design of future prospective clinical trials for children with CNS germinomas.