Abstract Background Metastatic intracranial germinoma in children is rare, and optimal management remains controversial. While craniospinal irradiation (CSI) is the standard of care, concerns regarding long-term toxicity prompted interest in chemotherapy-based regimens and irradiation dose reduction. This study compares survival outcomes across treatment modalities and identifies prognostic factors in pediatric metastatic germinoma. Methods A retrospective, multi-institutional cohort analysis was conducted, including patients aged 21 years with metastatic germinoma diagnosed between 2000 and 2022. Overall survival (OS) and event-free survival (EFS) were evaluated by treatment modality. Results Ninety-two patients (71% male; median age 13.9 years) were included. Primary tumor locations were pineal (34%), bifocal (31%), suprasellar (22%), and other (13%). CSI was administered to 83% (n = 74), with 71% (n = 63/89) receiving 21–24 Gy. Neoadjuvant chemotherapy was used in 62% (n = 57) of cases. At end of therapy, 74% (n = 68) achieved complete response, 16% (n = 15) partial response, and 1% (n = 1) stable disease. All three patients who did not receive irradiation experienced disease progression and died. Median follow-up was 58.5 months (range 2–264). Ten-year OS and EFS were 93.9% and 91.5%, respectively. CSI was associated with superior EFS compared to non-CSI regimens (p = 0.0009). Primary tumor location emerged as an independent prognostic factor, with bifocal, pineal, and suprasellar sites associated with improved outcomes compared to tumors in atypical locations. Conclusion CSI remains the cornerstone of curative therapy for metastatic germinoma, conferring superior EFS compared to non-CSI regimens. Neoadjuvant chemotherapy alone is insufficient but may enable safe CSI dose reduction. Prospective studies are needed to refine risk stratification and minimize long-term toxicity.
Shatara et al. (Tue,) studied this question.