Recent advances and racial differences in therapeutic strategy to the pineal region tumor

The therapeutic modalities for pineal region tumors in Western countries differ from those in Japan, mainly because of the different patient populations. The majority of pineal region tumors in Japan are radio- and/or chemosensitive, and adjuvant therapy rather than extensive surgery plays the main part in the treatment of these tumors. The specific clinical features of and therapeutic modalities for pineal region tumors, together with racial differences, were analyzed at the joint symposium of the Japanese Society for Pediatric Neurosurgery and the Korean Society for Pediatric Neurosurgery. The results of a cooperative study, together with the collective experience in Korea, confirmed that this specific patient population is nearly identical to the Japanese one. The new therapeutic approaches to pineal region tumors recommended included neuroendoscopic or stereotactic biopsy as a "minimally invasive" initial procedure. The adjuvant therapeutic modalities were further analyzed and neoadjuvant chemotherapy, mainly with cisplatin or carboplatin with or without etoposide (VP-16), was recommended for the treatment of germinoma and nongerminomatous malignant germ cell tumors. "Target radiation therapy" with extensive chemotherapy is a hopeful regimen and a future subject of research.