CNS Germ Cell Tumors ; Updates

Abstract

  Diagnosis and treatment approaches for central nervous system germ cell tumors (GCTs) have been evolving over decades ; however, they remain globally heterogeneous. There are major differences in how tumor markers and histopathological findings are weighed in Japan and Europe/North America at the time of diagnosis. It remains debatable whether non-germinomatous GCTs (NGGCTs) could be diagnosed solely based on elevated tumor markers without a biopsy, partly because of the suboptimal specificity of tumor markers of tumor tissues for future research. The historical three-class system in Japan (germinoma, intermediate prognosis group, and poor prognosis group) contrasts with the two-class system in Europe/North America (germinoma and NGGCTs). The difference stems from the debate over whether NGGCTs mixed with teratoma should be treated as intensively as other malignant NGGCTs. Hopefully, thorough analyses of previous clinical trials conducted across continents would result in clinical questions that would best guide the design of clinical trials. Additionally, the Intracranial GCT Genome Analysis Consortium of Japan (2012) has yielded multi-omics analyses on the pathogenesis, investigating the unique biological characteristics of GCTs. It is essential to conduct translational research based on biological investigation to develop novel treatments by unveiling crucial elements in the pathogenesis.