Chemotherapy Followed by Radiation Therapy in Treating Younger Patients With Newly Diagnosed Localized Central Nervous System Germ Cell Tumors

Inclusion Criteria:

   - Patients must be newly diagnosed with localized primary CNS NGGCT (Stratum 1) or
   localized primary CNS germinoma (Stratum 2); germ cell tumors located in the
   suprasellar, pineal, bifocal (pineal + suprasellar) and ventricles are eligible;
   tumors present in the above mentioned locations and with unifocal parenchymal
   extension are eligible

      - Stratum 1(NGGCT): Patients must have one of the following criteria:

         - Patients with serum and/or CSF hCGbeta > 100 mIU/mL or any elevation of
         serum and/or CSF alpha-fetoprotein (AFP) > 10 ng/mL or greater than the
         institutional normal are eligible, irrespective of biopsy results

         - Patients with any of the following elements on biopsy/resection are
         eligible, irrespective of serum and/or CSF hCGbeta and AFP levels:
         endodermal sinus tumor (yolk sac), embryonal carcinoma, choriocarcinoma,
         malignant/immature teratoma, and mixed GCT with malignant GCT elements

      - Stratum 2 (Germinoma): Patients must have both serum and CSF markers obtained
      (unless obtaining CSF is medically contraindicated) and must have one of the
      following criteria to be eligible:

         - Patients with institutional normal AFP (or =< 10 ng/mL if no institutional
         normal exists) in both serum and CSF (unless medically contraindicated) AND
         hCGbeta 5 to =< 50 mIU/mL in serum and/or CSF (unless medically
         contraindicated) (only 1 is required to be elevated) are eligible; no
         histologic confirmation required

         - Patients with bifocal (pineal + suprasellar) involvement or pineal lesion
         with diabetes insipidus (D1) AND hCGbeta =< 100 mIU/mL in serum and/or CSF
         AND institutional normal AFP (or =< 10 ng/mL if no institutional normal
         exists) in both serum and CSF (unless medically contraindicated) are
         eligible; no histologic confirmation required

         - Patients with histologically confirmed germinoma or germinoma mixed with
         mature teratoma and hCGbeta =< 100 mIU/mL in serum and/or CSF and
         institutional normal AFP (or =< 10 ng/mL if no institutional normal exists)
         in both serum and CSF (unless medically contraindicated) are eligible

   - All patients must have a cranial MRI with and without gadolinium at diagnosis/prior to
   enrollment; if surgical resection is performed, patients must have pre-operative and
   post-operative cranial MRI with and without gadolinium; the post-operative brain MRI
   should be obtained within 72 hours of surgery; if patient has a biopsy only,
   post-operative cranial MRI is recommended but not required; all patients must have a
   spine MRI with gadolinium obtained at diagnosis/prior to enrollment; Note: if the
   spine study is performed for the first time after surgical resection or biopsy, it is
   recommended to be obtained with and without gadolinium

   - Lumbar CSF must be obtained prior to study enrollment unless medically
   contraindicated; if a patient undergoes surgery and lumbar CSF cannot be obtained at
   this time, then it should be performed at least 10 days following surgery before study
   enrollment; false positive cytology can occur within 10 days of surgery; Note:
   patients with positive CSF cytology obtained prior to 10 days after surgery may have
   cytology repeated to determine eligibility

   - Patients must have CSF tumor markers obtained prior to enrollment unless medically
   contraindicated; ventricular CSF obtained at the time of CSF diversion procedure (if
   performed) is acceptable for tumor markers but lumbar CSF is preferred; in case CSF
   diversion and biopsy/surgery are combined, CSF tumor markers should be collected first

   - Patients must be enrolled on ALTE07C1 prior to enrollment on ACNS1123; patients must
   be enrolled within 31 days of definitive diagnostic surgery (day 0) or clinical
   diagnosis

   - Peripheral absolute neutrophil count (ANC) >= 1,000/uL

   - Platelet count >= 100,000/uL (transfusion independent)

   - Hemoglobin >= 8.0 g/dL (may receive red blood cell [RBC] transfusions)

   - Creatinine clearance or radioisotope glomular filtration rate (GFR) >= 70 mL/min/1.73
   m^2 OR serum creatinine based on age/gender as follows:

      - 0.8 mg/dL (2 to < 6 years of age)

      - 1.0 mg/dL (6 to < 10 years of age)

      - 1.2 mg/dL (10 to < 13 years of age)

      - 1.5 mg/dL (male) and 1.4 mg/dL (female) (13 to < 16 years of age)

      - 1.7 mg/dL (male) and 1.4 mg/dL (female) (>= 16 years of age)

   - Total bilirubin =< 1.5 times upper limit of normal (ULN) for age

   - Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) and
   serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) < 2.5
   times ULN

   - Patients with seizure disorder may be enrolled if well controlled

   - Patients must not be in status, coma, or assisted ventilation prior to study
   enrollment

Exclusion Criteria:

   - Patients with mature teratoma or completely resected immature teratoma with normal
   tumor markers are not eligible

   - Patients with tumors located outside the ventricles (basal ganglia, thalamus) are not
   eligible

   - Patients with metastatic disease by cranial or spinal MRI evaluation or CSF cytology
   (unless medically contraindicated) are not eligible

   - Patients must not have received any prior tumor-directed therapy other than surgical
   intervention and corticosteroids

   - Female patients who are pregnant are ineligible

   - Lactating females are not eligible unless they have agreed not to breastfeed their
   infants

   - Female patients of childbearing potential are not eligible unless a negative pregnancy
   test result has been obtained

   - Sexually active patients of reproductive potential are not eligible unless they have
   agreed to use an effective contraceptive method for the duration of their study
   participation

   - All patients and/or their parents or legal guardians must sign a written informed
   consent

   - All institutional, Food and Drug Administration (FDA), and National Cancer Institute
   (NCI) requirements for human studies must be met