Controversies in the management of intracranial germinomas

Intracranial germinomas are uncommon tumors. In the past, patients have traditionally been diagnosed with a trial of focal radiotherapy without biopsy. If the tumor was radiosensitive, it was presumed to be a germinoma. Because of the minimal morbidity and mortality associated with microsurgical techniques, almost all patients now have a histologic diagnosis and can be treated appropriately. Radiation therapy has been employed for the past three decades in the curative management of this disease. The long-term results have been excellent; however, current approaches have explored the possibility of reducing or even eliminating radiation therapy. This article provides a brief overview of intracranial germinomas and explores the controversies in the surgical, radiotherapeutic, and chemotherapeutic management of this tumor.