Table 3.

Radiation therapy for tumors of the pineal region.

Tumor Type	WHO Grade	Treatment Strategy	Extent of Irradiation and Dose Fractionation
Pure germinoma [73,74]	NA	RT in combination with ChT or as an exclusive treatment	Limited disease: WVI 24 Gy and tumor boost 16 Gy; WVI 18 Gy and boost 12 Gy in 1.6–1.8 Gy fractions for patients with complete response; metastatic disease: CSI alone 24 Gy and tumor boost 16 Gy in 1.8 Gy fractions;
Non-germinomatous germ cell tumor [76,77,78]	NA	Postoperative RT in combination with ChT	Limited disease: focal RT 54 Gy or CSI 30.4–36 Gy and tumor boost 18–23.4 Gy; Metastatic disease: CSI, 30.4–36 Gy and tumor boost 18–24 Gy in 1.8 Gy fractions;
Pineoblastoma [80,81]	4	Postoperative RT in combination with ChT	CSI 24–36 Gy and tumor boost 45–54 Gy in 1.8–2 Gy fractions
Pineal parenchymal tumor of intermediate differentiation [46]	2,3	Postoperative RT alone or in combination with ChT	Focal RT 50.4–54 Gy or CSI 24–36 Gy and tumor boost 45–54 Gy in 1.8–2 Gy fractions;
Papillary tumor of the pineal region [48]	2,3	Incompletely resected or recurrent tumors	Focal RT 50.4–54 Gy in 1.8–2 Gy fractions;
Pineocytoma [42]	1	Commonly not indicated. To be evaluated in recurrent inoperable tumors	Focal RT 50.4–54 Gy in 1.8–2 Gy fractions or SRS 15–18 Gy (small residual or recurrent tumors)

RT, radiation therapy; ChT, chemotherapy; WVI, whole ventricular irradiation; CSI, craniospinal irradiation; NA = not available.