Pineocytomas can be slow-growing or more aggressive, and can occur in children as well as adults. They are usually treated with surgery, if possible, and radiation therapy. Radiation therapy techniques for all these tumors often include craniospinal irradiation in addition to treatment of the primary tumor itself. Stereotactic radiotherapy integrated with conventional radiotherapy for intracranial germinomas. These tumors arise in one of the optic nerves or in the junction of the optic nerves, the optic chiasm.
Some physicians believe in observation if the tumor is only in one optic nerve.
If progression occurs, then surgery is often performed. Radiation therapy and chemotherapy are alternatives to surgery, since both are effective and can sometimes preserve the patient's vision. If the tumor involves the chiasm, then surgery is not an option because total removal will cause total blindness. Radiation therapy is used for older children, with chemotherapy usually given first in younger patients, saving radiation therapy for the case of disease progression. Chemotherapy can sometimes cure the tumor, and in other cases is useful in allowing the child to grow, which decreases the long-term effects of radiation.