Table 1.
Subjects, Clinical Questions, Recommendations, and Level of Recommendations
| Clinical Questions and Recommendations | Recommendation Level | |
|---|---|---|
| Subject 1 | Diagnosis and Classification | |
| CQ1 | Is measurement of tumor markers (AFP and HCG) useful in the management of CNS GCTs? | |
| Recommendation 1 | When primary CNS GCT is suspected, measurement of concentrations of tumor markers (AFP and HCG) in the blood and cerebrospinal fluid is recommended, unless medically contraindicated | 1A |
| CQ2 | Is histopathological diagnosis necessary in CNS GCTs? | |
| Recommendation 2 | When GCT is suspected, histopathological diagnosis is recommended to achieve definitive diagnosis | 2C |
| Subject 2 | Role of Surgery | |
| CQ3 | Is aggressive resection of germinoma necessary? | |
| Recommendation 3 | We strongly recommend against aggressive resection of germinoma | 1B |
| CQ4 | Is surgical resection of NGGCT necessary? | |
| Recommendation 4-1 | For mature teratomas, resection is strongly recommended | 1B |
| Recommendation 4-2 | For NGGCT other than mature teratoma, resection of residual tumor following chemo- (and radiotherapy) is strongly recommended | 1C |
| CQ5 | Is surgical intervention necessary for CNS GCT-associated hydrocephalus? | |
| Recommendation 5 | Surgical intervention, such as endoscopic third ventriculostomy, is strongly recommended to treat hydrocephalus | 1B |
| Subject 3 | Treatment for Germinoma | |
| CQ6 | Are chemo- and radiotherapy necessary for germinoma? | |
| Recommendation 6-1 | Radiation therapy covering the whole ventricle system together with chemotherapy is strongly recommended for germinoma without spinal dissemination | 1B |
| Recommendation 6-2 | Prophylactic spinal radiotherapy is not recommended for germinoma without spinal dissemination | 1C |
| Recommendation 6-3 | Treating germinoma with chemotherapy alone is strongly recommended against | 1B |
| Subject 4 | Treatment for NGGCT | |
| CQ7 | Are chemo- and radiotherapy effective for NGGCTs? | |
| Recommendation 7 | Chemo- and radiotherapy are strongly recommended for NGGCT excluding mature teratoma | 1B |
| Subject 5 | Treatment Strategy for Recurrence | |
| CQ8 | Is salvage treatment necessary for recurrent germinoma cases? | |
| Recommendation 8 | Treatment aimed at disease cure is strongly recommended | 1B |
| CQ9 | Is salvage treatment effective for recurrent NGGCTs? | |
| Recommendation 9 | Remission-oriented treatment is recommended, but palliative treatment is also recommended when treatment response is unfavorable | 2C |
| Subject 6 | Long-term Prognosis | |
| CQ10 | Is follow-up necessary for CNS GCT cases? | |
| Recommendation 10 | Follow-up for as long as possible is strongly recommended | 1B |
Abbreviations: AFP, α-fetoprotein; GCT, germ cell tumor; HCG, human chorionic gonadotropin; NGGCT, non-germinomatous germ cell tumor.