“…3,4,7,11,13,16) Germinomas occasionally recur more than 10 years after initial radiation therapy, including postoperative radiation therapy 4,10) and germinomas with STGC tend to recur later than pure germinomas. 11) This recurrence may be related to the field of irradiation rather than the dose, 8,13,16) suggesting the need for prophylactic irradiation of the whole spinal axis, 8,11,13,15) as eight of 22 patients (36.4%) suffered spinal metastasis. 13) The possibility of a relationship between direct surgery and spinal dissemination was proposed before the concept of germinoma with STGC was established.…”