State-of-the-Art Management of Germ Cell Tumors

A review of the state of the art in managing germ cell tumors (GCTs) in 2018 differs from that of virtually all other malignancies in which novel therapies releasing checkpoints in the immune system or targeting a mutation integral to the biology of the tumor are leading to unparalleled dramatic improvements in outcome with minute-to-minute change in the standard of care. Nevertheless, GCT enthusiasts can take solace in the fact that despite all of the progress being made in these other malignancies, sensitivity to available therapy and cure rates remain higher in the setting of metastatic GCTs than any other cancer, particularly if treatment is correctly applied.1,2 The truth is that in GCTs, there has not been as much of a change in treatment options as there has been reinforcement of the knowledge already learned and putting that knowledge into practice in the management of the disease. Despite a lack of new options for managing GCTs, the rarity of the tumor and multifaceted treatment continue to present difficult challenges for the busy oncologist and urologist. There are several nuances that are not easily acquired by treatment of one or two cases per year, and robust surgical experience with GCTs, particularly performance of retroperitoneal lymph node dissections, is limited to only a few centers in each country.3 Both historic and contemporary data indicate that patients treated at high-volume centers achieve superior outcomes to those treated in the community.4-6 The following review will focus on the most common pitfalls being made in clinical practice that prevent state-of-the-art management (Table 1). TABLE 1. Common Pitfalls in Germ Cell Tumor Management TABLE 1.Common Pitfalls in Germ Cell Tumor Management View larger version (416K) DIAGNOSIS AND STAGING Section: ChooseTop of pageAbstractDIAGNOSIS AND STAGING <