ID #312 Central Nervous System Immature Teratomas: A Comprehensive Literature Review
Fatima Elmenshawy, Jyoti Arora, Lorena Baroni, Mohamed AbdelbakiAbstract
Background
Central nervous system (CNS) immature teratomas are rare, aggressive non-germinomatous germ cell tumors lacking standardized management guidelines. Treatment strategies vary significantly regarding surgical extent and adjuvant therapies. We aimed to characterize treatment patterns, prognostic factors, and survival outcomes through a comprehensive literature review.
Methods
A structured review of English-language publications reporting histologically confirmed cases through June 2025 was performed. Data from 66 patients were analyzed using Kaplan-Meier methods and univariate Cox regression.
Results
The median age for diagnosis was 48 months (range: 0–576 months). Surgical resection was performed in 76.2% of patients, with gross total resection (GTR) achieved in 50.8%. The absence of surgical resection was the strongest predictor of mortality (HR 5.66, 95% CI 2.11–15.16; p < 0.001). Median overall survival (OS) was significantly lower for non-surgical patients (0.8 months) compared to those undergoing surgery (81 months) (p < 0.0001). While GTR showed a higher 12-month survival rate (95.0%) compared to less than GTR (73.1%). However, this did not reach statistical significance for OS (p = 0.120). Adjuvant chemotherapy (administered in 39.4%) and radiotherapy (31.8%) were not significantly associated with OS, event-free survival, or relapse. AFP and β-HCG elevations also lack independent prognostic value.
Conclusion
Surgical resection is the primary determinant of survival in CNS immature teratomas, providing a sustained survival advantage. The lack of independent benefit from current adjuvant regimens suggests a need for a surgery-centered approach. Prospective multi-institutional studies are required to optimize risk-adapted therapies.