What is your approach to management of a subtotally resected pineal parenchymal tumor of intermediate differentiation (CNS WHO grade 2)?

In full disclosure, I have had only one adult patient with PPTID. Although PPTID was first described in 1993, it was not recognized by the WHO until the 2000 classification and represents only 1% of primary central nervous system tumors. Prognosis falls somewhere between that of a pineocytoma and pi...

Agree with Dr. @Dr. First Last.

Have just treated a completely/near totally resected one of these with protons focally and no chemo. The evidence for both chemotherapy as well as focal vs CSI is difficult to determine. If subtotal resection would suggest XRT now, would likely be appropriate.

Would a...

Agree with Dr. @Dr. First Last's thorough and thoughtful perspective on the complex topic of adjuvant treatment in PPTID.

Data on the management of PPTID remains limited. Two larger series Mallick et al., PMID 27865543, and Lutterbach et al., PMID 12182434 suggest that PPTID, especially grade 3, have...