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Management of Specific Tumor Types and Locations

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    Embryonal Cell Tumors: Medulloblastomas

    Standard treatment options:

    • Surgery plus craniospinal radiation therapy for good-risk patients.[8]

    Treatment options under clinical evaluation:

    • Surgery plus craniospinal radiation therapy and various chemotherapy regimens are being evaluated for poor-risk patients.[8]

    Medulloblastoma occurs primarily in children, but it also occurs with some frequency in adults.[9] Other embryonal tumors are pediatric conditions. (Refer to the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for more information.)

    Pineal Parenchymal Tumors

    Standard treatment options:

    1. Surgery plus radiation therapy for pineocytoma.
    2. Surgery plus radiation therapy and chemotherapy for pineoblastoma.

    Pineocytoma (WHO grade II), pineoblastoma (WHO grade IV), and pineal parenchymal tumors of intermediate differentiation are diverse tumors that require special consideration. Pineocytomas are slow growing and carry variable prognoses for cure. Pineoblastomas are more rapidly growing and have worse prognoses. Pineal parenchymal tumors of intermediate differentiation have unpredictable growth and clinical behavior.

    Meningeal Tumors

    Grade I meningiomas

    Standard treatment options:

    1. Active surveillance with deferred treatment, especially for incidentally discovered asymptomatic tumors.[10,11].
    2. Surgery.
    3. Surgery plus radiation therapy is used in selected cases, such as for patients with known or suspected residual disease or with recurrence after previous surgery.
    4. Radiation therapy for patients with unresectable tumors.[12]

    WHO grade I meningiomas are usually curable when resectable. With the increasing use of sensitive neuroimaging tools, there has been greater detection of asymptomatic low-grade meningiomas. The majority appear to show minimal growth and can often be safely observed while therapy is deferred until growth or the development of symptoms.[10,11]

    Grade II and III meningiomas and hemangiopericytomas

    Standard treatment options:

    • Surgery plus radiation therapy.

    The prognoses for patients with meningiomas (WHO grade II) (i.e., atypical, clear cell, and chordoid), meningiomas (WHO grade III) (i.e., anaplastic/malignant, rhabdoid, and papillary), and hemangiopericytomas are worse than for patients with low-grade meningiomas because complete resections are less commonly feasible, and the proliferative capacity is greater.

    Germ Cell Tumors

    The prognosis and treatment of patients with germ cell tumors—which include germinoma, embryonal carcinoma, choriocarcinoma, and teratoma—depend on tumor histology, tumor location, presence and amount of biological markers, and surgical resectability.

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