Optimal Treatment Strategy for Central Nervous System Non-Germinomatous Germ Cell Tumors: A Systematic Review and Meta-Analysis

Background: To determine the optimal treatment modality for central nervous system (CNS) non-germinomatous germ cell tumors (NGGCTs).

Materials and methods: A search of Medline, Embase, Web of Science and Cochrane Library was conducted up to September 30, 2024. All studies were considered, covering all CNS NGGCT patients with an informative treatment approach. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated.

Results: Total 42 studies were included in the systematic review. Pooled risk ratio (RR) indicated a 28% lower failure rate for the gross total resection (GTR) compared to the non-GTR group [RR = 0.72, 95% CI (0.55, 0.95), P = 0.02]. Meta-analysis showed that craniospinal irradiation (CSI) was associated with a significantly lower failure rate for localized NGGCTs [RR = 0.53, 95% CI (0.38, 0.74), P = 0.0002]. Meta-analysis manifested that the risk of any failure event was 27% lower in the chemoradiotherapy group compared to radiotherapy alone [RR = 0.73, 95% CI (0.55, 0.98), P = 0.04]. Total 21 studies reported treatment-related acute and/or late toxicity, combination chemotherapy increased acute toxic, and expanded RT field and/or dose mainly increased late toxicity.

Conclusion: GTR was associated with better outcomes in terms of any failure event, and CSI was particularly beneficial for localized NGGCTs patients in reducing any failure event rate, and combination chemotherapy further reduced the failure risk. If CSI is combined with chemotherapy, the total RT dose can be appropriately reduced.