Pineal region tumors in children.
OBJECTIVE
Pineal tumors are rare in children, with pineoblastoma and germ cell tumors (GCTs) being the most common. Here we discuss recent advances in treatment and controversies in the management of these tumors.


RESULTS
There is significant heterogeneity in the clinical behavior of pineoblastoma in children. We will discuss differences in outcome of children with pineoblastoma who are less than and greater than 3 years of age, and between pineoblastoma and nonpineal supratentorial primitive neuro-ectodermal tumors when treated with multiple different strategies. Significant controversies exist in the treatment of GCTs as well, including the levels of tumor markers in the blood and cerebrospinal fluid that are required to establish without biopsy the diagnosis of a GCT, the role of surgery in GCTs and the optimal treatment for germinomas as well as mixed malignant GCTs.


CONCLUSIONS
Although pineoblastoma in infants and very young children still remains a therapeutic challenge, significant progress has been made in the treatment of pineal GCTs with treatment strategies using a combination of chemotherapy and reduced dose and volume irradiation, resulting in increased survival rates and reduced long-term morbidity.
Division of Pediatric Hematology-Oncology at Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027, USA. gdhall@chla.usc.edu
Girish
G
Dhall
Soumen
S
Khatua
Jonathan L
JL
Finlay
D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000592:standards; D024221:Antineoplastic Protocols / Q000592:standards*; D014408:Biomarkers, Tumor / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D006801:Humans; D007223:Infant; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010871:Pinealoma / Q000175:diagnosis* / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
D014408:Biomarkers, Tumor