Understanding Practice Variations in the Management of Central Nervous System Germ Cell Tumours : Insights from the NUGA Survey

Objective: Central nervous system germ cell tumours (CNS GCTs) are more prevalent in Asia than in Western populations. Treatment approaches remain heterogeneous across different Asian countries. Methods: Following a physical meeting of Asian specialists in Seoul in September 2024, an on-site and electronic survey was conducted among Asian specialists within the NeUro Germ cell Asia network to assess practice patterns and identify areas requiring consensus. Results: Forty-two specialists from eight Asian countries participated. Findings highlight the need for an Asian consortium to standardize management. Key variations were noted in age stratification, necessity of biopsy, tumour marker cut-offs, classification of bifocal disease and management of basal ganglia tumours, the role of chemotherapy in germinomas, and radiotherapy dose and volume for non-germinomatous germ cell tumours (NGGCTs). Conclusion: This survey identifies substantial practice variation in CNS GCT management across Asia. Priority areas requiring consensus include biopsy indications, tumour marker interpretation, age-adapted treatment strategies, the role of radiotherapy alone in adolescent and young adult germinoma, and optimisation of chemotherapy and radiotherapy approaches for NGGCT.