Management of Germ Cell Tumours of the Testes in Adult Patients: German Clinical Practice Guideline, PART II – Recommendations for the Treatment of Advanced, Recurrent, and Refractory Disease and Extragonadal and Sex Cord/Stromal Tumours and for the Management of Follow-Up, Toxicity, Quality of Life, Palliative Care, and Supportive Therapy

Abstract

<b><i>Objectives:</i></b> We developed the first German evidence- and consensus-based clinical guideline on diagnosis, treatment, and follow-up of germ cell tumours (GCT) of the testes in adult patients. We present the guideline content in 2 separate publications. The present second part summarizes the<b><i></i></b>recommendations for the treatment of advanced disease stages and for the management of follow-up and late effects. <b><i>Materials and Methods:</i></b> An interdisciplinary panel of 42 experts including 1 patient representative developed the guideline content. Clinical recommendations and statements were based on scientific evidence and expert consensus. For this purpose, evidence tables for several review questions, which were based on systematic literature searches (last search in March 2018), were provided. Thirty-one experts, who were entitled to vote, rated the final clinical recommendations and statements. <b><i>Results:</i></b> Here we present the treatment recommendations separately for patients with metastatic seminoma and non-seminomatous GCT (stages IIA/B and IIC/III), for restaging and treatment of residual masses, and for relapsed and refractory disease stages. The recommendations also cover extragonadal and sex cord/stromal tumours, the management of follow-up and toxicity, quality-of-life aspects, palliative care, and supportive therapy. <b><i>Conclusion:</i></b> Physicians and other medical service providers who are involved in the diagnostics, treatment, and follow-up of GCT (all stages, outpatient and inpatient care as well as rehabilitation) are the users of the present guideline. The guideline also comprises quality indicators for measuring the implementation of the guideline recommendations in routine clinical care; these data will be presented in a future publication.

Therapy of clinical stage IIA and IIB seminoma: a systematic review

“…Accounting for only 7% of all TC patients, clinical stage (CS) IIA/B seminoma, defined as disease spread to the retroperitoneal lymph nodes of up to 2 cm (CS IIA) or of more than 2 cm to up to 5 cm (CS IIB) in maximum diameter, is a rare disease [3,4]. Established national and international TC guidelines recommend radiotherapy (RT) or chemotherapy (CT) for the treatment of CS IIA/B seminoma patients [5,6]. However, high-level evidence to define the optimal treatment remains elusive [5,6].…”

Indications, feasibility and outcome of robotic retroperitoneal lymph node dissection for metastatic testicular germ cell tumours

“…As indications for pR-RPLND in CS 1 disease, due to the nowadays most often applied treatment options of surveillance or one cycle of chemotherapy, have almost vanished, our study shows the wide indications for R-RPLND in mTGCT in a real-world setting 2 , 3 , 5 . Of note, several patients with special indications were included—seminoma patients in CS 2A, patients at relapse under surveillance, a patient at late relapse after chemotherapy and pc seminoma patients.…”

“…So far, only one other publication exists on R-RPLND in a mere mTGCT patient collective, comprising both pR-RPLND (n = 22) and pcR-RPLND (n = 4) patients 28 . Such reports define the possibilities of R-RPLND for mTGCT patients, taking into account the nearly vanished relevance of pR-RPLND in CS 1 patients, in whom the treatment options nowadays are surveillance or one cycle of chemotherapy in high-risk patients 2 , 3 , 5 . Additionally, no direct comparison between pR-RPLND and pcR-RPLND in mTGCT has been made.…”

“…Retroperitoneal lymph node dissection (RPLND) is an important column of TGCT treatment, though it has a shrinking importance in clinical stage (CS) 1 2 – 5 . Nevertheless, in metastatic TGCT (mTGCT), RPLND remains an integral part of treatment in both the primary (p) and post-chemotherapeutic (pc) setting 2 , 4 . To date, RPLND is mainly performed by open surgery, and has ever since been associated with a relatively high complication rate 6 .…”

Contemporary options and future perspectives: three examples highlighting the challenges in testicular cancer imaging

“…Currently, computed tomography (CT) is the standard imaging modality for initial staging, recommended by national and international TGCT treatment guidelines [5,[10][11][12].…”