Management of Germ Cell Tumours of the Testis in Adult Patients. German Clinical Practice Guideline Part I: Epidemiology, Classification, Diagnosis, Prognosis, Fertility Preservation, and Treatment Recommendations for Localized Stages

TY - JOUR

T1 - Management of Germ Cell Tumours of the Testis in Adult Patients. German Clinical Practice Guideline Part I: Epidemiology, Classification, Diagnosis, Prognosis, Fertility Preservation, and Treatment Recommendations for Localized Stages

AU - Kliesch, Sabine

AU - Schmidt, Stefanie

AU - Wilborn, Doris

AU - Aigner, Clemens

AU - Albrecht, Walter

AU - Bedke, Jens

AU - Beintker, Matthias

AU - Beyersdorff, Dirk

AU - Bokemeyer, Carsten

AU - Busch, Jonas

AU - Classen, Johannes

AU - de Wit, Maike

AU - Dieckmann, Klaus-Peter

AU - Diemer, Thorsten

AU - Dieing, Anette

AU - Gockel, Matthias

AU - Göckel-Beining, Bernt

AU - Hakenberg, Oliver W

AU - Heidenreich, Axel

AU - Heinzelbecker, Julia

AU - Herkommer, Kathleen

AU - Hermanns, Thomas

AU - Kaufmann, Sascha

AU - Kornmann, Marko

AU - Kotzerke, Jörg

AU - Krege, Susanne

AU - Kristiansen, Glen

AU - Lorch, Anja

AU - Müller, Arndt-Christian

AU - Oechsle, Karin

AU - Ohloff, Timur

AU - Oing, Christoph

AU - Otto, Ulrich

AU - Pfister, David

AU - Pichler, Renate

AU - Recken, Heinrich

AU - Rick, Oliver

AU - Rudolph, Yvonne

AU - Ruf, Christian

AU - Schirren, Joachim

AU - Schmelz, Hans

AU - Schmidberger, Heinz

AU - Schrader, Mark

AU - Schweyer, Stefan

AU - Seeling, Stefanie

AU - Souchon, Rainer

AU - Winter, Christian

AU - Wittekind, Christian

AU - Zengerling, Friedemann

AU - Zermann, Dirk-Henrik

AU - Zillmann, Roger

AU - Albers, Peter

N1 - © 2021 The Author(s). Published by S. Karger AG, Basel.

PY - 2021/1/7

Y1 - 2021/1/7

N2 - INTRODUCTION: This is the first German evidence- and consensus-based clinical guideline on diagnosis, treatment, and follow-up on germ cell tumours (GCTs) of the testis in adult patients. We present the guideline content in two publications. Part I covers the topic's background, methods, epidemiology, classification systems, diagnostics, prognosis, and treatment recommendations for the localized stages.METHODS: 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 was in March 2018) were provided. Thirty-one experts entitled to vote, rated the final clinical recommendations and statements.RESULTS: We provide 161 clinical recommendations and statements. We present information on the quality of cancer care and epidemiology and give recommendations for staging and classification as well as for diagnostic procedures. The diagnostic recommendations encompass measures for assessing the primary tumour as well as procedures for the detection of metastases. One chapter addresses prognostic factors. In part I, we separately present the treatment recommendations for germ cell neoplasia in situ, and the organ-confined stages (clinical stage I) of both seminoma and nonseminoma.CONCLUSION: Although GCT is a rare tumour entity with excellent survival rates for the localized stages, its management requires an interdisciplinary approach, including several clinical experts. Quality of care is highly related to institutional expertise and can be reassured by established online-based second-opinion boards. There are very few studies on diagnostics with good level of evidence. Treatment of metastatic GCTs must be tailored to the risk according to the International Germ Cell Cancer Collaboration Group classification after careful diagnostic evaluation. An interdisciplinary approach as well as the referral of selected patients to centres with proven experience can help achieve favourable clinical outcomes.

AB - INTRODUCTION: This is the first German evidence- and consensus-based clinical guideline on diagnosis, treatment, and follow-up on germ cell tumours (GCTs) of the testis in adult patients. We present the guideline content in two publications. Part I covers the topic's background, methods, epidemiology, classification systems, diagnostics, prognosis, and treatment recommendations for the localized stages.METHODS: 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 was in March 2018) were provided. Thirty-one experts entitled to vote, rated the final clinical recommendations and statements.RESULTS: We provide 161 clinical recommendations and statements. We present information on the quality of cancer care and epidemiology and give recommendations for staging and classification as well as for diagnostic procedures. The diagnostic recommendations encompass measures for assessing the primary tumour as well as procedures for the detection of metastases. One chapter addresses prognostic factors. In part I, we separately present the treatment recommendations for germ cell neoplasia in situ, and the organ-confined stages (clinical stage I) of both seminoma and nonseminoma.CONCLUSION: Although GCT is a rare tumour entity with excellent survival rates for the localized stages, its management requires an interdisciplinary approach, including several clinical experts. Quality of care is highly related to institutional expertise and can be reassured by established online-based second-opinion boards. There are very few studies on diagnostics with good level of evidence. Treatment of metastatic GCTs must be tailored to the risk according to the International Germ Cell Cancer Collaboration Group classification after careful diagnostic evaluation. An interdisciplinary approach as well as the referral of selected patients to centres with proven experience can help achieve favourable clinical outcomes.

U2 - 10.1159/000510407

DO - 10.1159/000510407

M3 - SCORING: Review article

C2 - 33412555

VL - 105

SP - 169

EP - 180

JO - UROL INT

JF - UROL INT

SN - 0042-1138

IS - 3-4

ER -