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Strategy of combined treatment of germ cell tumors.

The histopathological entity 'germ cell tumor' (GCT) encompasses a number of histological subtypes. Pineal GCTs can be grossly divided into three categories: those with a good, intermediate, and poor prognostic. Germinoma and mature teratoma are curable and classified into the good prognostic group, whereas embryonal carcinoma, yolk sac tumor, and other highly malignant neoplasms leave patients with a dismal prognosis. There are other types of GCT that have an intermediate prognosis, such as immature teratoma. Only mature teratomas are curable by surgical resection alone; the other types require adjuvant therapy. To plan a surgical strategy, then eurosurgeon has to acquire enough knowledge of the effect of adjuvant therapies and biological behavior of the GCTs. Germinoma can be cured by low-dose radiotherapy in combination with chemotherapy, and nowadays needs only to be biopsied. Other tumors, such as highly malignant tumors need a sophisticated combination therapy that includes surgery, craniospinal radiation therapy, and intensive chemotherapy. An appropriate neoadjuvant therapy prior toradical surgical removal will remarkably reduce the surgical risk. The goal of treatment should be tightly focused on the reduction of posttreatment sequelae, including surgical morbidity, and not on a complete microsurgical resection.