Radiation Therapy Compared With Chemotherapy and Radiation Therapy in Treating Patients With Newly Diagnosed Primary Central Nervous System (CNS) Germ Cell Tumor

DISEASE CHARACTERISTICS:

   - Histologically confirmed primary CNS pure germ cell tumor

      - Diagnosed within the past 31 days

   - Meets any 1 OR none (i.e., M0 [localized disease]) of the following staging criteria:

      - M+ (disseminated disease)

         - Leptomeningeal or intraventricular metastases visualized on MRI scans of the
         brain and spine

         - Clumps of tumor cells on lumbar cerebrospinal fluid (CSF) cytology

         - Visible tumor studding the walls of the lateral or third ventricles noted
         during endoscopy or surgery

         - Primary tumor arising within the parenchyma of the brain, brainstem, or
         spinal cord

         - Measurable multi-focal tumors arising in both the pineal and suprasellar
         regions (i.e., multiple midline tumors)

         - Infiltrative, intra-axial extension on brain MRI > 1 cm beyond enhancing
         tumor

      - Modified M+ (occult multi-focal disease)

         - M0 at diagnosis with a localized pineal region tumor with signs and symptoms
         of diabetes insipidus without measurable disease in the suprasellar region

   - Lumbar CSF assay meeting criteria for the following marker profiles:

      - Serum and CSF beta human chorionic gonadotropin (β-HCG) ≤ 50 IU/dL

      - Serum alpha fetoprotein (AFP) ≤ 10 IU/L AND ≤ institutional norm

      - CSF AFP ≤ 2.0 IU/L AND ≤ institutional norm

PATIENT CHARACTERISTICS:

Age

   - 3 to 25

Performance status

   - Not specified

Life expectancy

   - Not specified

Hematopoietic

   - Absolute neutrophil count > 1,000/mm^3

   - Platelet count > 100,000/mm^3 (transfusion independent)

   - Hemoglobin > 10.0 g/dL (transfusion allowed)

Hepatic

   - Bilirubin ≤ 1.5 times upper limit of normal (ULN)

   - aspartate aminotransferase (AST) or alanine aminotransferase (ALT) < 2.5 times ULN

Renal

   - Creatinine adjusted according to age as follows*:

      - No greater than 0.4 mg/dL (≤ 5 months)

      - No greater than 0.5 mg/dL (6 months -11 months)

      - No greater than 0.6 mg/dL (1 year-23 months)

      - No greater than 0.8 mg/dL (2 years-5 years)

      - No greater than 1.0 mg/dL (6 years-9 years)

      - No greater than 1.2 mg/dL (10 years-12 years)

      - No greater than 1.4 mg/dL (13 years and over [female])

      - No greater than 1.5 mg/dL (13 years to 15 years [male])

      - No greater than 1.7 mg/dL (16 years and over [male]) AND

   - Creatinine clearance OR radioisotope glomerular filtration rate > 70 mL/min

Other

   - Not pregnant or nursing

   - Negative pregnancy test

   - Fertile patients must use effective contraception

   - Euthyroid (with or without levothyroxine sodium therapy) as determined by normal T4 ±
   thyroid-stimulating hormone levels*

   - Diabetes insipidus allowed provided patient is relatively stable on desmopressin
   acetate

   - Normal endogenous cortisol function*

   - Adequate antidiuretic hormone reserves* NOTE: *Unless receiving replacement therapy

PRIOR CONCURRENT THERAPY:

Biologic therapy

   - Not specified

Chemotherapy

   - Not specified

Endocrine therapy

   - Concurrent replacement hormones allowed (e.g., corticosteroids, levothyroxine sodium,
   and desmopressin acetate)

Radiotherapy

   - Not specified

Surgery

   - Prior surgery for germ cell tumor allowed

Other

   - No other prior therapy for germ cell tumor

   - Concurrent anticonvulsants allowed