CNS GcT Literature Review

An extensive literature review identified more than 25 reports over the past 40 years describing results of single-institutional, multi-institutional, and study group retrospective reviews as well as a small number of papers describing tumor response in formal phase 2 and 3 trials and studies of quality of life (QoL) outcomes. The earliest report, by Wara et al. [110], con cluded that germinoma was radiocurable, but the metastatic recurrence risk was such that CrSp RT was recommended. Another report, by Jennings et al. [110], reviewed the literature for 399 cases, and concluded that anatomical staging was critical to identify high-risk patients with metastases and suggested that NGGCTs could benefit from additive chemotherapy. In that publication, there was a discussion regarding the biology of GCTs with respect to endogenous surges of sex hormone around puberty as a drive for GCT development [111]. These two very early reports set the scene for two decades of evolution of clinical practice, resulting in current therapies. Primary surgery, followed by combined adjuvant chemotherapy and RT has led to survival rates for GGCTs that exceed 95%, and for NGGCTs that reach nearly 70%. Reports of QoL in survivors, although sparse, have shown substantial improvements over the last two decades.

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