Treatment of intracranial germ cell tumors (GCTs)

AFP: alpha-fetoprotein; hCG: human chorionic gonadotropin; MRI: magnetic resonance imaging; CSF: cerebrospinal fluid; SOC: standard of care; CSI: craniospinal irradiation; WVI: whole-ventricular irradiation; WVSCI: whole-ventricular and spinal cord irradiation; RT: radiation therapy.

* International consensus is lacking on the magnitude of hCG elevation that reliably distinguishes a germinoma from an NGGCT.

¶ The choice between RT alone and neoadjuvant chemotherapy plus response-adapted RT in germinoma is individualized; combination therapy is favored in younger patients. Refer to UpToDate topic on intracranial GCTs for more details.

Δ Mature teratoma has normal AFP and hCG.