Safe to Skip Primary Tumor Boosts in Pediatric Germinomas

The study covered in this summary was published on as a preprint and has not yet been peer reviewed.

Key Takeaway

  • Primary tumor boosts — an extra dose of radiation specifically to the tumor bed — does not improve survival after chemotherapy and general radiation for germinomas in children, even if they have residual tumor.

Why This Matters

  • Chemotherapy followed by radiation is the standard-of-care for pediatric germinomas.

  • It has been unclear whether residual disease at the end of treatment requires an additional boost of radiation to the tumor bed.

  • The findings confirm previous reports that it is safe to skip the extra dose of radiation and spare children the consequences of additional radiation.

Study Design

  • The team reviewed information from 29 children treated for germinomas with chemotherapy and radiation but who did not receive a primary tumor boost.

  • Overall, 25 children had localized disease and four had metastatic disease at presentation.

  • All children received multi-agent chemotherapy; most had a complete response (82.8%) and three (10.3%) had a partial response. 

  • Patients then underwent 23.4 Gy in 13 fractions of either ventricular, whole brain, or craniospinal irradiation based on tumor location.

  • There was no additional tumor response from radiation among the three children who had partial responses to chemotherapy.  

Key Results

  • After a median follow-up of 63 months, there were no local relapses even among children with residual disease.

  • Five-year progression free survival was 91%, and overall survival was 100%, both comparable to previous reports of germinoma treatment with primary tumor boosts.


  • It was a small, single-center review.

  • The three children classified as partial responders included two with basal ganglia tumors in whom treatment response could not actually be determined.


  • There was no external funding, and the investigators did not report any disclosures.

This is a summary of a preprint research study, “Time to Dismiss Boost? Outcomes of Children With Localized and Metastatic Germinoma,” led by Jen Chun Foo, MBBS, of The Hospital for Sick Children, Toronto, provided to you by Medscape. The study has not been peer reviewed. The full text can be found at

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: [email protected]

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