Advances in Urology

Germ Cell Tumors: Updates on Epidemiology, Biology, and Treatment Considerations


Publishing date
16 Feb 2018
Status
Published
Submission deadline
29 Sep 2017

Lead Editor

1University of Texas Southwestern Medical Center, Dallas, USA

2Indiana University Medical Center, Indianapolis, USA

2Indiana University Medical Center, Indianapolis, USA


Germ Cell Tumors: Updates on Epidemiology, Biology, and Treatment Considerations

Description

Germ cell tumors (GCTs) are the most common solid tumors in young men. GCTs represent a rare oncologic success story with 5-year cure rates >98% for early stage tumors and >80% even for patients with metastatic disease owing to the integration of surgery, cisplatin-based chemotherapy, and radiation therapy. Despite the excellent clinical outcomes in testicular GCTs, significant challenges and opportunities exist. The current optimal treatment for many patients is unknown due to the need to balance oncologic outcomes with toxicity of therapy. Patients with stage I tumors, which are the most common, have the option of observation with the risk for recurrence, retroperitoneal lymph node dissection with attendant surgical risks, or primary chemotherapy with risk of organ damage and future secondary malignancies. Among patients with advanced disease, up to 30% of advanced GCT patients exhibit cisplatin-resistance, requiring intensive salvage treatment and conferring a 50% risk of cancer-related death.

There is certainly room for improvement in managing patients with germ cell tumors, and it is critical that the urology, oncology, and radiooncology communities do not rest on the laurels of our past successes. We must understand the changing epidemiology of germ cell tumors to better identify risk factors that can potentially be modified. Acknowledging and overcoming socioeconomic barriers to the complex coordinated care that is required for optimal outcomes is also imperative. Unique considerations for patients with pediatric and adolescent GCTs must also be recognized to improve outcomes among this subgroup. Minimizing short, intermediate, and long-term treatment-related toxicity is also mandatory for these young cancer survivors who have a whole life to live. These active areas of research are promising avenues to improve oncologic and treatment-related outcomes in patients with GCTs.

Patients with germ cell tumors represent the highest number of life years lost for any nonpediatric tumors, and the management of patients with high risk and cisplatin-resistant disease is another arena where we can improve upon existing results. Early initiation of historical salvage-only regimens (Paclitaxel, Ifosfamide, and Cisplatin) in treatment-naïve high-risk patients may improve outcomes. The optimal type of salvage chemotherapy to administer (conventional versus high-dose) is currently under investigation. Further, understanding the biology of advanced germ cell tumors may allow for novel treatment options for patients with cisplatin-resistant disease as could an improved understanding of immune-oncology as a therapeutic strategy in patients with platinum-resistant disease. On the whole, the future is bright for the optimal and refined management of patients with germ cell tumors.

Potential topics include but are not limited to the following:

  • Germ cell tumors: epidemiologic shifts, new insights into biology, and opportunities for improvement
  • Germ cell tumor genomics: translating biologic understanding into rationale for novel treatment options
  • Epidemiologic considerations in germ cell tumors
  • Treatment trends in germ cell tumors
  • Pediatric germ cell tumors: unique concepts
  • Adolescent germ cell tumors: special considerations
  • Conditional risk of relapse in surveillance for patients with NSGCT
  • Retroperitoneal lymph node dissection for patients with Stage I-IIA seminoma
  • Robotic-assisted laparoscopic retroperitoneal lymph node dissection: evolution of technique and early results
  • Adjuvant therapy for stage IB germ cell tumors: one versus two cycles of BEP
  • The use of modified templates in early and advanced stage nonseminoma
  • Retroperitoneal lymph node dissection in the setting of elevated markers
  • Controversies in management of good risk germ cell tumor: impact of chemotherapy regimen on retroperitoneal histology
  • Paclitaxel, Ifosfamide, and Cisplatin or Bleomycin, Etoposide, and Cisplatin as first-line treatment in intermediate or poor risk germ cell tumors
  • Long-term toxicities associated with systemic chemotherapy and radiation therapy for testicular cancer
  • Management of extraretroperitoneal residual masses
  • Interpreting positron emission tomography (PET) imaging in postchemotherapy seminoma
  • Conventional dose versus high dose chemotherapy for relapsed germ cell tumors
  • Immunooncology-related concepts in germ cell tumors

Articles

  • Special Issue
  • - Volume 2018
  • - Article ID 4821084
  • - Editorial

Germ Cell Tumors: Updates on Epidemiology, Biology, and Treatment Considerations

Aditya Bagrodia | Costantine Albany | Timothy A. Masterson
  • Special Issue
  • - Volume 2018
  • - Article ID 2146080
  • - Review Article

A Review of Outcomes and Technique for the Robotic-Assisted Laparoscopic Retroperitoneal Lymph Node Dissection for Testicular Cancer

Zeyad R. Schwen | Mohit Gupta | Phillip M. Pierorazio
  • Special Issue
  • - Volume 2018
  • - Article ID 6783147
  • - Review Article

The Use of Modified Templates in Early and Advanced Stage Nonseminomatous Germ Cell Tumor

Timothy A. Masterson | Clint Cary
  • Special Issue
  • - Volume 2018
  • - Article ID 8781698
  • - Review Article

Adjuvant Therapy for Stage IB Germ Cell Tumors: One versus Two Cycles of BEP

Robert A. Huddart | Alison M. Reid
  • Special Issue
  • - Volume 2018
  • - Article ID 7272541
  • - Review Article

Conventional-Dose versus High-Dose Chemotherapy for Relapsed Germ Cell Tumors

Deaglan J. McHugh | Darren R. Feldman
  • Special Issue
  • - Volume 2018
  • - Article ID 3718165
  • - Review Article

Immune-Related Concepts in Biology and Treatment of Germ-Cell Tumors

Michal Chovanec | Ugo De Giorgi | Michal Mego
  • Special Issue
  • - Volume 2018
  • - Article ID 7182014
  • - Review Article

Dissecting the Evolving Risk of Relapse over Time in Surveillance for Testicular Cancer

Madhur Nayan | Robert J. Hamilton
  • Special Issue
  • - Volume 2018
  • - Article ID 8671832
  • - Review Article

Toxicities Associated with Cisplatin-Based Chemotherapy and Radiotherapy in Long-Term Testicular Cancer Survivors

Chunkit Fung | Paul Dinh | ... | Lois B. Travis
  • Special Issue
  • - Volume 2018
  • - Article ID 9059382
  • - Review Article

Pediatric Germ Cell Tumors: A Developmental Perspective

Joshua L. Pierce | A. Lindsay Frazier | James F. Amatruda
  • Special Issue
  • - Volume 2018
  • - Article ID 7978958
  • - Review Article

Retroperitoneal Lymph Node Dissection as Primary Treatment for Metastatic Seminoma

Brian Hu | Siamak Daneshmand
Advances in Urology
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Acceptance rate16%
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