Universität zu Köln

Winter, Christian, Zengerling, Friedemann, Busch, Jonas, Heinzelbecker, Julia ORCID: 0000-0001-8993-7171, Pfister, David, Ruf, Christian, Lackner, Julia, Albers, Peter, Kliesch, Sabine, Schmidt, Stefanie and Bokemeyer, Carsten (2022). How to classify, diagnose, treat and follow-up extragonadal germ cell tumors? A systematic review of available evidence. World J. Urol., 40 (12). S. 2863 - 2879. NEW YORK: SPRINGER. ISSN 1433-8726

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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 classification, 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 identified 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 classified according to the IGCCCG classification. 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-intensified 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 intensification 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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Winter, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Zengerling, Friedemann UNSPECIFIED UNSPECIFIED UNSPECIFIED Busch, Jonas UNSPECIFIED UNSPECIFIED UNSPECIFIED Heinzelbecker, Julia UNSPECIFIED orcid.org/0000-0001-8993-7171 UNSPECIFIED Pfister, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Ruf, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Lackner, Julia UNSPECIFIED UNSPECIFIED UNSPECIFIED Albers, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Kliesch, Sabine UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmidt, Stefanie UNSPECIFIED UNSPECIFIED UNSPECIFIED Bokemeyer, Carsten UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-692454
DOI:	10.1007/s00345-022-04009-z
Journal or Publication Title:	World J. Urol.
Volume:	40
Number:	12
Page Range:	S. 2863 - 2879
Date:	2022
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1433-8726
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PROGNOSTIC-FACTORS; CANCER; CLASSIFICATION; MEDIASTINUM; OUTCOMES; CHEMOTHERAPY; EXPERIENCE; VARIABLES; EMPHASIS; FEATURES Multiple languages Urology & Nephrology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/69245