Malignant extracranial germ cell tumours (MEGCTs) represent a biologically heterogeneous group of malignancies with manifestation influenced by age, sex, site and the relationship of the tumour to puberty, although histologically they may be similar between sites (1, 2). MEGCTs are rare and comprise approximately 3% of all childhood tumours (3). However the incidence rises sharply at the time of puberty, and MEGCTs are the most common solid tumour in adolescents and young adults exhibiting similar behaviour (4). Traditional treatments included mainly surgery and chemotherapy, although testicular and mediastinal seminomas (5)(which are rare in children) and ovarian dysgerminomas are radiotherapy sensitive. The improved efficacy of chemotherapy regimens over time eclipsed the need for radiotherapy where undue toxicity could be avoided or minimised with chemotherapy alone. Consequently, radiotherapy has not been incorporated into first line treatment regimens in children. Instead radiotherapy continues to be used for refractory or relapsed tumours as a salvage strategy for poor chemotherapy responders and even then, has not been shown to add significant benefit (6).