CONCLUSIONS
Patients with DS treated for CNS GCTs are at an increased risk of treatment-related death, particularly from treatment-related infection. Based on our experience, we suggest that a different therapeutic approach may be considered for this patient population in which treatment intensity is reduced. To evaluate the long-term effects of RT and chemotherapy in these patients, longer follow-up is needed. An expanded multi-institutional analysis is warranted, as well as subgroup specific analysis for DS patients within prospective clinical trials of CNS GCTs.