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Titel: How to classify, diagnose, treat and follow-up extragonadal germ cell tumors? A systematic review of available evidence
VerfasserIn: Winter, Christian
Zengerling, Friedemann
Busch, Jonas
Heinzelbecker, Julia
Pfister, David
Ruf, Christian
Lackner, Julia
Albers, Peter
Kliesch, Sabine
Schmidt, Stefanie
Bokemeyer, Carsten
Sprache: Englisch
Titel: World journal of Urology
Verlag/Plattform: Springer Nature
Erscheinungsjahr: 2022
Freie Schlagwörter: Extragonadal germ cell tumors (EGCTs)
Primary mediastinal germ cell tumors
Primary retroperitoneal germ cell tumors
Chemotherapy
Seminoma
Non-seminoma
DDC-Sachgruppe: 610 Medizin, Gesundheit
Dokumenttyp: Journalartikel / Zeitschriftenartikel
Abstract: Purpose To present the current evidence and the development of studies in recent years on the management of extragonadal germ cell tumors (EGCT). Methods A systematic literature search was conducted in Medline and the Cochrane Library. Studies within the search period (January 2010 to February 2021) that addressed the classifcation, diagnosis, prognosis, treatment, and follow-up of extragonadal tumors were included. Risk of bias was assessed and relevant data were extracted in evidence tables. Results The systematic search identifed nine studies. Germ cell tumors (GCT) arise predominantly from within the testis, but about 5% of the tumors are primarily located extragonadal. EGCT are localized primarily mediastinal or retroperitoneal in the midline of the body. EGCT patients are classifed according to the IGCCCG classifcation. Consecutively, all mediastinal non-seminomatous EGCT patients belong to the “poor prognosis” group. In contrast mediastinal seminoma and both retroperitoneal seminoma and non-seminoma patients seem to have a similar prognosis as patients with gonadal GCTs and metastasis at theses respective sites. The standard chemotherapy regimen for patients with a EGCT consists of 3–4 cycles (good vs intermediate prognosis) of bleomycin, etoposid, cisplatin (BEP); however, due to their very poor prognosis patients with non-seminomatous mediastinal GCT should receive a dose-intensifed or high-dose chemotherapy approach upfront on an individual basis and should thus be referred to expert centers Ifosfamide may be exchanged for bleomycin in cases of additional pulmonary metastasis due to subsequently planned resections. In general patients with non-seminomatous EGCT, residual tumor resection (RTR) should be performed after chemotherapy. Conclusion In general, non-seminomatous EGCT have a poorer prognosis compared to testicular GCT, while seminomatous EGGCT seem to have a similar prognosis to patients with metastatic testicular seminoma. The current insights on EGCT are limited, since all data are mainly based on case series and studies with small patient numbers and non-comparative studies. In general, systemic treatment should be performed like in testicular metastatic GCTs but upfront dose intensifcation of chemotherapy should be considered for mediastinal non-seminoma patients. Thus, EGCT should be referred to interdisciplinary centers with utmost experience in the treatment of germ cell tumors.
DOI der Erstveröffentlichung: 10.1007/s00345-022-04009-z
URL der Erstveröffentlichung: https://link.springer.com/article/10.1007/s00345-022-04009-z
Link zu diesem Datensatz: urn:nbn:de:bsz:291--ds-377046
hdl:20.500.11880/34107
http://dx.doi.org/10.22028/D291-37704
ISSN: 1433-8726
Datum des Eintrags: 25-Okt-2022
Fakultät: M - Medizinische Fakultät
Fachrichtung: M - Urologie und Kinderurologie
Professur: M - Prof. Dr. Michael Stöckle
Sammlung:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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