European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG)

Abstract

Germ cell tumour is the most frequent malignant tumour type in young men with a 100% rise in the incidence every 20 years. Despite this, the high sensitivity of germ cell tumours to platinum-based chemotherapy, together with radiation and surgical measures, leads to the high cure rate of > or = 99% in early stages and 90%, 75-80% and 50% in advanced disease with 'good', 'intermediate' and 'poor' prognostic criteria (IGCCCG classification), respectively. The high cure rate in patients with limited metastatic disease allows the reduction of overall treatment load, and therefore less acute and long-term toxicity, e.g. organ sparing surgery for specific cases, reduced dose and treatment volume of irradiation or substitution of node dissection by surveillance or adjuvant chemotherapy according to the presence or absence of vascular invasion. Thus, different treatment options according to prognostic factors including histology, stage and patient factors and possibilities of the treating centre as well may be used to define the treatment strategy which is definitively chosen for an individual patient. However, this strategy of reduction of treatment load as well as the treatment itself require very high expertise of the treating physician with careful management and follow-up and thorough cooperation by the patient as well to maintain the high rate for cure. Treatment decisions must be based on the available evidence which has been the basis for this consensus guideline delivering a clear proposal for diagnostic and treatment measures in each stage of gonadal and extragonadal germ cell tumour and individual clinical situations. Since this guideline is based on the highest evidence level available today, a deviation from these proposals should be a rare and justified exception.

Management and outcome of bilateral testicular germ cell tumors: Twenty-five year experience in Munich

“…Based on the favorable outcome of patients with a secondary metachronous TGCT reported so far, we do not recommend routine biopsy of the contralateral testicle. However, a contralateral biopsy might be discussed with patients at high risk of TIN [44,45].…”

Evidence-based pragmatic guidelines for the follow-up of testicular cancer: optimising the detection of relapse

“…The reasons for this increasing incidence and the aetiology of TGCTs remain unknown. The European Germ Cell Cancer Consensus Group has provided clear guidelines for the primary treatment of both seminoma tumour and NSGCT (Schmoll et al, 2004). There is, however, a lack of clear consensus on how to follow patients after primary treatment, and a number of issues dictate that follow-up should be carefully thought out and rigorously adhered to.…”

Elevated serum levels of IGF-binding protein 2 in patients with non-seminomatous germ cell cancer: correlation with tumor markers α-fetoprotein and human chorionic gonadotropin

“…Non-seminomas can be further classified histologically into embryonal carcinomas, teratomas (mature and immature), choriocarcinomas, yolk sac tumors, and tumors with mixed histological features (2). Prognosis and choice of the adequate therapeutic regimen are dependant on tumor stage and additional clinical criteria, in particular with regard to the extent of tumor marker elevation (3)(4)(5)(6). Testicular germ cell tumors are thought to be derived from cells in the germ cell lineage at different stages of development, which are blocked in maturation (2).…”