Skip to main content

Latest Recommendations of the European Germ Cell Cancer Group on Diagnosis and Treatment of Germ Cell Cancer

  • Chapter
Diagnosis and Management of Testicular Cancer

Abstract

In 2004, the first European Consensus Paper concerning diagnosis and treatment of germ cell cancer was published (Schmoll et al. Ann Oncol 15:1377–1399, 2004). The consensus group consisted of more than 60 experts from all across Europe. The experts involved were oncologists, urologic surgeons, radiooncologists, pathologists and basic scientists. Since then, regular updates were performed by the group (Krege et al. Eur Urol 53:478–496, 2008; Krege et al. Eur Urol 53:497–513, 2008), the latest published in 2012 (Beyer et al. Ann Oncol 24:878–888, 2013). In this chapter, the recent recommendations of the European group are summarized. The following chapters will present some topics in detail, which are still discussed controversial, or for which the best management is not yet found.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Schmoll H-J, Souchon R, Krege S, et al. European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG). Ann Oncol. 2004;15:1377–99.

    Article  CAS  PubMed  Google Scholar 

  2. Krege S, Beyer J, Souchon R, et al. European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): part I. Eur Urol. 2008;53:478–96.

    Article  PubMed  Google Scholar 

  3. Krege S, Beyer J, Souchon R, et al. European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): part II. Eur Urol. 2008;53:497–513.

    Article  PubMed  Google Scholar 

  4. Beyer J, Albers P, Altena R, et al. Maintaining success, reducing treatment burden, focusing on survivorship: highlights from the third European consensus conference on diagnosis and treatment of germ-cell cancer. Ann Oncol. 2013;24:878–88.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Steiner H, Höltl L, Maneschg C, et al. Frozen section analysis-guided organ-sparing approach in testicular tumors: technique, feasibility, and long-term results. Urology. 2003;62:508–13.

    Article  PubMed  Google Scholar 

  6. Heidenreich A, Weissbach L, Höltl W, et al. Organ sparing surgery for malignant germ cell tumor of the testis. J Urol. 2001;166:2161–5.

    Article  CAS  PubMed  Google Scholar 

  7. Dieckmann K-P, Kulejewski M, Pichlmeier U, Loy V. Diagnosis of contralateral testicular intraepithelial neoplasia (TIN) in patients with testicular germ cell cancer: systematic two-site biopsies are more sensitive than a single random biopsy. Eur Urol. 2007;51:175–85.

    Article  PubMed  Google Scholar 

  8. Dieckmann K-P, Kulejewski M, Heinemann V, et al. Testicular biopsy for early cancer detection – objectives, technique and controversies. Int J Androl. 2011;34:e7–13.

    Article  PubMed  Google Scholar 

  9. Christensen TB, Daugaard G, Geertsen PF, et al. Effect of chemotherapy on carcinoma in situ of the testis. Ann Oncol. 1998;9:657–60.

    Article  CAS  PubMed  Google Scholar 

  10. Eble JN, Sauter G, Epstein JI, Sesterhenn IA. Pathology and genetics. Tumours of the urinary system and male genital organs, WHO classification of tumours. Lyon: IARC Press; 2004.

    Google Scholar 

  11. Wittekind CH, Meyer H-J, editors. UICC: TNM classification of malignant tumours. 7th ed. New York: Wiley-Liss; 2010.

    Google Scholar 

  12. International Germ Cell Cancer Collaborative Group (IGCCCG). The International Germ Cell Consensus Classification: a prognostic factor based staging system for metastatic germ cell cancer. J Clin Oncol. 1997;15:594–603.

    Google Scholar 

  13. Hansen J, Jurik AG. Diagnostic value of multislice computed tomography and magnetic resonance imaging in the diagnosis of retroperitoneal spread of testicular cancer: a literature review. Acta Radiol. 2009;50:1064–70.

    Article  CAS  PubMed  Google Scholar 

  14. Huddart RA, O’Doherty MJ, Padhani A, et al. 18 fluorodeoxyglucose positron emission tomography in the prediction of relapse in patients with high risk, clinical stage I nonseminomatous germ cell tumors: preliminary report of MRC Trial TE22 – the NCRI Testis Tumour Clinical Study Group. J Clin Oncol. 2007;25:3090–5.

    Article  PubMed  Google Scholar 

  15. De Wit M, Brenner W, Hartmann M, et al. (18F)-FDG-PET in clinical stage I/II non-seminomatous germ cell tumours: results of the German multicentre trial. Ann Oncol. 2008;19:1619–23.

    Article  PubMed  Google Scholar 

  16. Gilligan T, Seidenfeld J, Basch EM. American Society of Clinical Oncology Clinical practice Guidelines on the uses of tumor markers in adult males with germ cell tumors. J Clin Oncol. 2010;28:3388–404.

    Article  CAS  PubMed  Google Scholar 

  17. Warde P, Specht L, Horwich A, et al. Prognostic factors for relapse in stage I seminoma managed by surveillance: a pooled analysis. J Clin Oncol. 2002;20:4448–52.

    Article  PubMed  Google Scholar 

  18. Lewinshtein D, Gulati R, Nelson PS, Porter CR. Incidence of second malignancies after external beam radiotherapy for clinical stage I Testicular seminoma. BJU Int. 2012;109:706–12.

    Article  PubMed  Google Scholar 

  19. Horwich A, Fossa SD, Huddart R, et al. Second cancer risk and mortality in men treated with radiotherapy for stage I seminoma. Br J Cancer. 2014;110:256–63.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Oliver TD, Mead GM, Gordon JS, et al. Randomized trial of carboplatin versus radiotherapy for stage I seminoma: mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 Study. J Clin Oncol. 2011;29:957–62.

    Article  CAS  PubMed  Google Scholar 

  21. Chung PW, Daugaard G, Tydlesley S, et al. Prognostic factors for relapse in stage I seminoma managed with surveillance: a validation study. J Clin Oncol. 2010;28:15s (abstract 4535).

    Google Scholar 

  22. Aparicio J, Maroto P, del Muro XG, et al. Risk adapted treatment in clinical stage I seminoma: the third Spanish germ cell cancer group study. J Clin Oncol. 2011;29:4677–81.

    Article  PubMed  Google Scholar 

  23. Tandstad T, Stahl O, Hakansson U, et al. One course of adjuvant BEP in clinical stage I nonseminoma mature and expanded Results from the SWENOTECA group. Ann Oncol. 2014;25:2167–72.

    Google Scholar 

  24. Nicolai N, Miceli R, Necchi A, et al. Retroperitoneal lymph node dissection with no adjuvant chemotherapy in clinical stage I nonseminomatous germ cell tumours: long-term outcome and analysis of risk factors of recurrence. Eur Urol. 2010;58:912–8.

    Article  PubMed  Google Scholar 

  25. Garcia-del-Muro X, Maroto P, Guma J, et al. Chemotherapy as an alternative to radiotherapy in the treatment of stage IIA and IIB testicular seminoma: a Spanish germ cell cancer group study. J Clin Oncol. 2008;26:5416–21.

    Article  CAS  PubMed  Google Scholar 

  26. Culine S, Kerbat P, Kramar A, et al. Refining the optimal chemotherapy regimen for good risk metastatic nonseminomatous germ-cell tumors: a randomised trial of the Genito-Urinary Group of the French Federation of Cancer Centers (GETUG T93BP). Ann Oncol. 2007;18:917–24.

    Article  CAS  PubMed  Google Scholar 

  27. Grimison PS, Martin R, Stockler MR, et al. Comparison of two standard chemotherapy regimens for good-prognosis germ cell tumors: updated analysis of a randomised trial. J Natl Cancer Inst. 2010;102:1253–62.

    Article  CAS  PubMed  Google Scholar 

  28. de Wit R, Stoter G, Sleijfer DT, et al. Four cycles of BEP versus four cycles of VIP in patients with intermediate prognosis metastatic testicular non-seminoma: a randomised study of the EORTC Genitourinary Tract Cancer Cooperative Group. European Organization for Research and Treatment of Cancer. Br J Cancer. 1998;78:828–32.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Nichols CR, Catalano PJ, Crawford ED, et al. Randomized comparison of cisplatin and etoposide and either bleomycin or ifosfamide in treatment of advanced disseminated germ cell tumors: an Eastern Cooperative Oncology Group, Southwest Oncology Group, and Cancer and Leukemia Group B Study. J Clin Oncol. 1998;16:1287–93.

    CAS  PubMed  Google Scholar 

  30. Daugaard G, Skoneczna I, Aass N, et al. A randomized phase III study comparing standard dose BEP with sequential high- dose cisplatin, etoposide, and ifosfamide (VIP) plus stem cell support in males with poor prognosis germ cell cancer. An intergroup study of EORTC, GTCSG, and Grupo Germinal (EORTC 30974). Ann Oncol. 2011;22:1054–61.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Motzer RJ, Nichols CJ, Margolin LA, et al. Phase III randomised trial of conventional-dose chemotherapy with or without high-dose chemotherapy and autologous hematopoietic stem-cell rescue as first-line treatment for patients with poor-prognosis metastastic germ cell tumors. J Clin Oncol. 2007;25:247–56.

    Article  CAS  PubMed  Google Scholar 

  32. De Santis M, Becherer A, Bokemeyer C, et al. 2–18 fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: an update of the prospective multicentric SEMPET trial. J Clin Oncol. 2004;22:1034–9.

    Article  PubMed  Google Scholar 

  33. Bachner M, Loriot Y, Gross-Goupil M, et al. 2–18 fluoro-deoxy-D-glucose positron emission tomography (FDG-PET) for postchemotherapy seminoma residual lesions: a retrospective validation of the SEMPET trial. Ann Oncol. 2012;23:59–64.

    Article  CAS  PubMed  Google Scholar 

  34. Beck SD, Foster RS, Bihrle R, et al. Is full bilateral retroperitoneal lymph node dissection always necessary for postchemotherapy residual tumor? Cancer. 2007;110:1235–40.

    Article  PubMed  Google Scholar 

  35. Heidenreich A, Pfister D, Witthuhn R, et al. Postchemotherapy retroperitoneal lymph node dissection in advanced testicular cancer: radical or modified template resection. Eur Urol. 2009;55:217–26.

    Article  PubMed  Google Scholar 

  36. Ravi P, Gray KP, Donnell EKO, Sweeney CJ. A meta-analysis of patient outcomes with subcentimeter disease after chemotherapy for metastatic non-seminomatous germ cell tumor. Ann Oncol. 2014;25:331–8.

    Article  CAS  PubMed  Google Scholar 

  37. Besse B, Grunenwald D, Flechon A, et al. Nonseminomatous germ cell tumors: assessing the need for postchemotherapy contralateral pulmonary resection in patients with ipsilateral complete necrosis. J Thorac Cardiovasc Surg. 2009;137:448–52.

    Article  PubMed  Google Scholar 

  38. Schirren J, Trainer S, Eberlein M, et al. The role of residual tumor resection in the management of nonseminomatous germ cell cancer of testicular origin. J Thorac Cardiovasc Surg. 2012;60:405–12.

    Article  Google Scholar 

  39. Fizazi K, Oldenburg J, Dunant A, et al. Assessing prognosis and optimising treatment in patients with postchemotherapy viable nonseminomatous germ-cell tumors (NSCGT): results of the sCR2 international study. Ann Oncol. 2008;19:259–64.

    Article  CAS  PubMed  Google Scholar 

  40. Murphy AM, McKiernan JM. Reoperative retroperitoneal lymph-node dissection for testicular germ cell tumor. World J Urol. 2009;27:501–6.

    Article  PubMed  Google Scholar 

  41. Spiess PE, Kassouf W, Brown GA, et al. Surgical management of growing teratoma syndrome: the M.D. Anderson Cancer Center experience. J Urol. 2007;177:1330–4.

    Article  PubMed  Google Scholar 

  42. Lee DJ, Djaladat H, Tadros NN, et al. Growing teratoma syndrome: clinical and radiographic characteristics. Int J Urol. 2014;21:905–8.

    Article  PubMed  Google Scholar 

  43. Fazel R, Krumholz HM, Wang Y, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med. 2009;361:849–57.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  44. Rustin GJ, Mead GM, Sally P, et al. Randomized trial of two or five computed tomography scans in the surveillance of patients with stage I nonseminomatous germ cell tumors of the testis: Medical Research Council Trial TE 08 – The International Cancer Research Institute Testis Cancer Clinical Studies Group. J Clin Oncol. 2007;10:1310–5.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Susanne Krege .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Krege, S. (2015). Latest Recommendations of the European Germ Cell Cancer Group on Diagnosis and Treatment of Germ Cell Cancer. In: Krege, S. (eds) Diagnosis and Management of Testicular Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-17467-9_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-17467-9_1

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-17466-2

  • Online ISBN: 978-3-319-17467-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics