Materiały źródłowe

• #1 Treatment of germ cell testicular cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8212650/

  Germ-cell testicular cancer (GCTC) is a malignant neoplasm derived from the primordial germ cell. […] Two main groups are seminomas and non-seminomas, each accounting for 50% of cases, and they differ in treatment modalities and response to therapy. […] Despite increase in the incidence rate, a promising circumstance is that GCTC has become a model of curable cancer. Because of advances in diagnostic procedures, sophisticated radiation techniques and especially the introduction of cisplatin based chemotherapy protocols together with advanced postchemotherapy surgical techniques, curability is expected in about 95% of all patients diagnosed with testicular cancer and over 70% of patients with advanced disease. […] In this review, we will focus on treatment strategies of primary GCTC.

• #2 Germ cell tumors – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/germ-cell-tumors/diagnosis-treatment/drc-20580169

  Treatments for germ cell tumors may include surgery, chemotherapy and radiation therapy. […] Surgery is often used to take out a germ cell tumor. The kind of surgery used to remove a germ cell tumor may depend on the tumor’s location. If a tumor in a testicle might be cancer, surgery often includes removing the entire testicle. […] Chemotherapy treats cancer with strong medicines. Many chemotherapy medicines exist. Most chemotherapy medicines are given through a vein. Some come in pill form. […] Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on the body.

• #3 Germ Cell Brain Tumor Treatment | St. Jude Care & Treatment

  https://www.stjude.org/care-treatment/treatment/childhood-cancer/brain-tumors/germ-cell-tumors-brain.html

  Most germ cell tumors are treated with chemotherapy along with radiation therapy. […] Chemotherapy (chemo) uses powerful medicines to kill cancer cells or stop them from spreading. […] Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or stop them from growing. […] Surgery to diagnose the tumor type (biopsy) and to remove all or part of the tumor is needed in certain situations. Your oncologist will discuss with you the role of surgery. […] Our brain tumor clinical trials have led to better therapies in children. These improvements include lower-dose therapies, targeted therapy, and proton therapy. These treatments kill cancer cells while sparing healthy cells and may lessen the severity of side effects that affect brain function after treatment for some types of brain tumors.

• #4 Germ Cell Tumor: Causes & Symptoms

  https://my.clevelandclinic.org/health/diseases/23505-germ-cell-tumor

  Surgery is the primary treatment for germ cell tumors. Your provider may remove the tumor from the affected ovary (ovarian cystectomy) or the entire ovary and fallopian tubes (salpingo-oophorectomy). With testicular cancer, your provider will remove the testicle with the tumor. […] Chemotherapy uses drugs to destroy cancer cells or prevent them from dividing. You might receive chemotherapy if your provider cant remove the tumor safely or if it has spread to other parts of your body. You may receive chemotherapy to destroy any remaining cancer cells following surgery, even if you cant see the cancer cells on imaging. Chemotherapy is an effective treatment for most types of germ cell tumors. […] Radiation therapy directs high-energy X-rays to cancer cells to destroy them. Some types of germ cell tumors respond best to radiation therapy.

• #5 Treatment of germ cell testicular cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8212650/

  Stage I is defined as a tumor limited to the testis, without retroperitoneal lymph node involvement or visceral metastases and with normal postorchiectomy serum tumor markers at primary diagnosis. […] Following orchiectomy, there are 3 options recommended for the management of stage I seminoma, as follows: active surveillance, adjuvant treatment with radiotherapy to para-aortic lymph nodes, or adjuvant 1-2 cycles of chemotherapy with carboplatin, dosed at the area under the curve (AUC) of 7. […] The most encouraging fact is that in case of relapse, the overall 5-year disease specific survival is 99%, independent of the 3 management options mentioned above. […] Postorchiectomy treatment options for stage II seminoma include radiotherapy to para-aortic and ipsilateral iliac lymph nodes to the cumulative dose of 30-36 Gy, multi agent cisplatin based chemotherapy with 3 cycles of cisplatin, etoposide and bleomycin protocol (PEB protocol) or 4 cycles of cisplatin, etoposide protocol (PE protocol). […] The National Comprehensive Cancer Network (NCCN) testicular cancer guidelines treatment plan is based on dividing stage II into low volume disease and bulky disease, depending on the maximal size of lymph node mass.

• #6 Germ cell tumor – Wikipedia

  https://en.wikipedia.org/wiki/Germ_cell_tumor

  Treatment typically involves a combination of surgery and chemotherapy, depending on the subtype and location of the tumor. Surgery is performed upfront for testicular and ovarian tumors, as biopsies are associated with peritoneal and scrotal tumor seeding. […] Benign GCTs such as mature teratomas (dermoid cysts) are cured by simple excision. […] Testicular germ cell tumors are treated by orchiectomy, followed by surveillance, lymph node staging, and/or chemotherapy depending on the risk stratification defined by the International Germ Cell Cancer Collaborative Group (IGCCCG). […] Treatment for ovarian germ cell tumors typically involves at least ovarian cystectomy. Removal of the ovaries, fallopian tube, uterus, and retroperitoneal lymph nodes may be planned depending on patient age, reproductive status, and extent of disease.

• #7 Germ cell tumours | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-children/germ-cell-tumours/

  Most children who develop germ cell tumours will be cured. […] The treatment your child will have usually depends on a number of factors, including the size, position and stage of the tumour. It usually includes either surgery or chemotherapy, or a combination. […] A benign tumour can be cured if it is removed by surgery. It may mean removing a testicle or an ovary if this is where the tumour started. […] If the tumour is malignant and can be completely removed with surgery, chemotherapy is not always needed, especially if it began in the testis or ovary. If the tumour cannot be removed easily or has spread, your child will be given chemotherapy. […] Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Germ cell tumours are very sensitive to chemotherapy. Its usually given as injections and drips (infusions) into a vein.

• #8 Surgery for Germ Cell Tumors | NYU Langone Health

  https://nyulangone.org/conditions/germ-cell-tumors-in-children/treatments/surgery-for-germ-cell-tumors

  Surgeons at Hassenfeld Childrens Hospital at NYU Langone remove many types of benign and malignant germ cell tumors. The surgery used for germ cell tumors depends on the type, size, and location of the tumor. Chemotherapy may be used to shrink large tumors before surgery to make them easier to remove. […] Surgery alone can cure some malignant germ cell tumors in the gonads—the ovaries or testicles. For germ cell tumors in the testicles, a surgeon removes the tumor and one or both testicles through a small incision in the groin. For ovarian germ cell tumors, which typically appear on one ovary, the surgeon removes the tumor, the ovary, and the fallopian tube through a small incision in the abdomen. Leaving one ovary or testicle when possible can help preserve fertility. […] Surgery for extragonadal tumors—those located outside the gonads—depends on the location of the tumor. Some tumors can’t be completely removed because they are wrapped in nerves or arteries that supply blood to organs or are pressed against an important organ, such as the heart. A surgical procedure called tumor debulking, or cytoreduction, is used to remove as much of this kind of tumor or as many of these tumors as possible. […] After surgery, chemotherapy is used to destroy any remaining malignant tumor or tumors, which are typically smaller than 1 centimeter.

• #9 Germ cell tumours | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-children/germ-cell-tumours/

  Most children who develop germ cell tumours will be cured. […] The treatment your child will have usually depends on a number of factors, including the size, position and stage of the tumour. It usually includes either surgery or chemotherapy, or a combination. […] A benign tumour can be cured if it is removed by surgery. It may mean removing a testicle or an ovary if this is where the tumour started. […] If the tumour is malignant and can be completely removed with surgery, chemotherapy is not always needed, especially if it began in the testis or ovary. If the tumour cannot be removed easily or has spread, your child will be given chemotherapy. […] Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Germ cell tumours are very sensitive to chemotherapy. Its usually given as injections and drips (infusions) into a vein.

• #10 Treatment of Ovarian Germ Cell Tumors – NCI

  https://www.cancer.gov/types/ovarian/patient/ovarian-germ-cell-treatment-pdq

  Ovarian germ cell tumors are usually cured if found and treated early. […] There are different types of treatment for patients with ovarian germ cell tumors. […] The following types of treatment are used: Surgery, Observation, Chemotherapy, Radiation therapy. […] Surgery is the most common treatment of ovarian germ cell tumor. A doctor may take out the cancer using one of the following types of surgery. […] After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. […] Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.

• #11 Treatment protocols for germ cell tumors – UpToDate

  https://www.uptodate.com/contents/treatment-protocols-for-germ-cell-tumors

  Treatment protocols for germ cell tumors […] The following material represents a subset of chemotherapy and immunotherapy regimens that are used for the treatment of patients with advanced germ cell tumors. This is not an exhaustive list; it includes regimens that are considered by the authors and editors to be commonly used and important for the care of both male and female patients with germ cell tumors. […] This topic review is intended to provide only a listing of chemotherapy and immunotherapy regimens. […] Regimens: BEP (bleomycin plus etoposide and cisplatin), EP (etoposide plus cisplatin), TIP (paclitaxel plus ifosfamide and cisplatin), VIP (etoposide plus ifosfamide and cisplatin), VeIP (vinblastine plus ifosfamide and cisplatin). […] Systemic therapy regimens for germ cell tumors: Bleomycin, etoposide, and cisplatin (BEP), Cisplatin and etoposide, Paclitaxel, ifosfamide, and cisplatin (TIP), Cisplatin, etoposide, and ifosfamide (VIP), Vinblastine, ifosfamide, and cisplatin (VeIP).

• #12 Treatment of germ cell testicular cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8212650/

  Stage I is defined as a tumor limited to the testis, without retroperitoneal lymph node involvement or visceral metastases and with normal postorchiectomy serum tumor markers at primary diagnosis. […] Following orchiectomy, there are 3 options recommended for the management of stage I seminoma, as follows: active surveillance, adjuvant treatment with radiotherapy to para-aortic lymph nodes, or adjuvant 1-2 cycles of chemotherapy with carboplatin, dosed at the area under the curve (AUC) of 7. […] The most encouraging fact is that in case of relapse, the overall 5-year disease specific survival is 99%, independent of the 3 management options mentioned above. […] Postorchiectomy treatment options for stage II seminoma include radiotherapy to para-aortic and ipsilateral iliac lymph nodes to the cumulative dose of 30-36 Gy, multi agent cisplatin based chemotherapy with 3 cycles of cisplatin, etoposide and bleomycin protocol (PEB protocol) or 4 cycles of cisplatin, etoposide protocol (PE protocol). […] The National Comprehensive Cancer Network (NCCN) testicular cancer guidelines treatment plan is based on dividing stage II into low volume disease and bulky disease, depending on the maximal size of lymph node mass.

• #13 Treatment of germ cell testicular cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8212650/

  Following orchiectomy, there are 3 recommended options for the management of stage I non-seminoma, including active surveillance, adjuvant chemotherapy with 1-2 cycles of chemotherapy with PEB protocol, or primary nerve-sparing retroperitoneal lymph node dissection (p-RPLND). […] Each option has a cure rate of 99%. […] For stage IIC, there is a universal consensus about the indication for postorchiectomy chemotherapy with 3 cycles of PEB protocol or 4 cycles of PE protocol. […] After primary treatment with p-RPLND, adjuvant chemotherapeutic treatment should be considered depending on the number and size of positive lymph nodes. […] The preferred regimen for good-risk patients is 3 cycles of PEB protocol, which showed the same cure benefit as 4 cycles, but with significant reduction of toxicity. […] The preferred postorchiectomy regimen for those patients is 4 cycles of PEB protocol.

• #14

  https://link.springer.com/article/10.1007/s12094-024-03532-2

  An absolute or relative contraindication to bleomycin may exist in patients over 40 years of age, those with pulmonary disease, heavy smokers, athletes or professionals who require a high lung capacity, and those with mediastinal tumors or lung metastases, especially if extensive pulmonary resection or radiation is planned after chemotherapy. […] If there is a contraindication to bleomycin in patients with IGCCCG good prognosis tumors, four cycles of EP may be used as an alternative, although slightly statistically non-significant worse results have been reported in two randomised trials in NSGCT. […] Patients who fail first-line cisplatin-based chemotherapy should be classified according to the International Prognostic Factor Study Group (IPFSG) classification, a risk prognostic model based on a large retrospective series.

• #15 Germ cell ovarian cancer | Macmillan Cancer Support

  https://www.macmillan.org.uk/cancer-information-and-support/ovarian-cancer/germ-cell-ovarian-cancer

  You may have chemotherapy after surgery to treat any cancer cells left behind, reduce the risk of the cancer coming back, or treat germ cell ovarian cancer that has come back. […] The most common chemotherapy drugs used to treat germ cell ovarian cancer are: bleomycin, etoposide, cisplatin. […] Treatment does not usually affect your fertility (being able to get pregnant). […] If there is a risk your fertility may be affected, you may be referred to a fertility expert. […] If both ovaries are removed you will not be able to get pregnant and will start menopause straight away.

• #16 Ovarian Germ Cell Tumor Treatment | Ovarian Teratoma Treatment | American Cancer Society

  https://www.cancer.org/cancer/types/ovarian-cancer/treating/germ-cell-tumors.html

  If dysgerminoma is limited to one ovary, surgery to remove that ovary and the fallopian tube on the same side might be the only treatment needed, without chemo after surgery. This approach requires close follow-up so that if the cancer comes back it can be found early and treated. Most women in this stage are cured with surgery and never need chemo. […] A grade 1 immature teratoma is made up mostly of non-cancerous tissue, and only a few cancerous areas are seen. These tumors rarely come back after being removed. If careful staging has determined that a grade 1 immature teratoma is limited to one or both ovaries, surgery to remove the ovary or ovaries containing the cancer and the fallopian tube or tubes might be the only treatment needed. […] Treatment for recurrent or persistent germ cell tumors might include surgery, chemo or, rarely, radiation therapy. For chemo, a combination of drugs is used most often. PEB (cisplatin, etoposide, and bleomycin) may be used if this combination of drugs was not used before. For women who have already been treated with PEB, other drug combinations are used. […] For recurrent or persistent germ cell cancer, a clinical trial for new treatments may provide important advantages.

• #17 Treatment of Ovarian Germ Cell Tumors – NCI

  https://www.cancer.gov/types/ovarian/patient/ovarian-germ-cell-treatment-pdq

  Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. […] High-dose chemotherapy with bone marrow transplant is a method of giving very high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. […] Treatment of dysgerminoma may include: Unilateral salpingo-oophorectomy with or without lymphangiography or CT scan, Unilateral salpingo-oophorectomy followed by observation, Unilateral salpingo-oophorectomy followed by radiation therapy, Unilateral salpingo-oophorectomy followed by chemotherapy. […] Treatment of other ovarian germ cell tumors may include: unilateral salpingo-oophorectomy followed by careful observation; or unilateral salpingo-oophorectomy, sometimes followed by combination chemotherapy.

• #18 Germ Cell Tumor Treatment: Comprehensive Approaches and Advances

  https://www.linkedin.com/pulse/germ-cell-tumor-treatment-comprehensive-approaches-nikhil-chidrawar-5t3wf

  Germ cell tumor treatment refers to the medical interventions and therapies employed to treat tumors that originate from germ cells, which are cells that develop into sperm in men and eggs in women. Germ cell tumor can occur in the testicles, ovaries, and various other parts of the body, such as the abdomen, chest, and brain. […] Surgery is often the first line of treatment for localized germ cell tumors, especially when the tumor is resectable. […] Chemotherapy is the cornerstone of treatment for advanced or metastatic germ cell tumors and is also used for high-risk early-stage disease. […] Radiation therapy is particularly effective for seminomas, which are highly radiosensitive. […] High-dose chemotherapy followed by autologous stem cell transplantation is considered for patients with relapsed or refractory germ cell tumors.

• #19 Treatment of germ cell testicular cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8212650/

  Stage I is defined as a tumor limited to the testis, without retroperitoneal lymph node involvement or visceral metastases and with normal postorchiectomy serum tumor markers at primary diagnosis. […] Following orchiectomy, there are 3 options recommended for the management of stage I seminoma, as follows: active surveillance, adjuvant treatment with radiotherapy to para-aortic lymph nodes, or adjuvant 1-2 cycles of chemotherapy with carboplatin, dosed at the area under the curve (AUC) of 7. […] The most encouraging fact is that in case of relapse, the overall 5-year disease specific survival is 99%, independent of the 3 management options mentioned above. […] Postorchiectomy treatment options for stage II seminoma include radiotherapy to para-aortic and ipsilateral iliac lymph nodes to the cumulative dose of 30-36 Gy, multi agent cisplatin based chemotherapy with 3 cycles of cisplatin, etoposide and bleomycin protocol (PEB protocol) or 4 cycles of cisplatin, etoposide protocol (PE protocol). […] The National Comprehensive Cancer Network (NCCN) testicular cancer guidelines treatment plan is based on dividing stage II into low volume disease and bulky disease, depending on the maximal size of lymph node mass.

• #20 Germ Cell Tumors (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/germ-cell.html

  Children with malignant tumors may have surgery to remove as many of the cancerous cells as possible. […] Chemotherapy works to treat cancer throughout the body. Chemo is also the most important therapy to treat microscopic (very tiny) cells that can hide in other parts of the body but aren’t seen on a scan or felt on exam. Often, doctors combine several chemotherapy drugs to attack the cancer cells in different ways. […] This treatment uses high-energy radiation from X-rays, gamma rays, or fast-moving subatomic particles (called particle or proton beam therapy) to target and destroy cancer cells. Radiation usually isn’t needed to treat germ cell tumors because most are very sensitive to chemotherapy.

• #21 Germ cell tumours | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-children/germ-cell-tumours/

  Treatment of malignant germ cell tumours in the brain is a little different. Although they are very sensitive to chemotherapy, treatment with radiotherapy is also needed. Radiotherapy is the use of high-energy rays to destroy cancer cells. Unlike germ cell tumours elsewhere in the body, its not always necessary to remove germ cell tumours in the brain with surgery. […] Treatment often causes side effects, and your childs doctor will discuss these with you before treatment starts. […] The side effects of chemotherapy usually gradually improve when treatment is over and many of them can be well controlled. […] A small number of children may develop long-term side effects of treatment, sometimes many years later. These are not common but may include problems with how the kidneys or lungs work and some hearing loss.

• #22 Treatment of germ cell testicular cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8212650/

  Following orchiectomy, there are 3 recommended options for the management of stage I non-seminoma, including active surveillance, adjuvant chemotherapy with 1-2 cycles of chemotherapy with PEB protocol, or primary nerve-sparing retroperitoneal lymph node dissection (p-RPLND). […] Each option has a cure rate of 99%. […] For stage IIC, there is a universal consensus about the indication for postorchiectomy chemotherapy with 3 cycles of PEB protocol or 4 cycles of PE protocol. […] After primary treatment with p-RPLND, adjuvant chemotherapeutic treatment should be considered depending on the number and size of positive lymph nodes. […] The preferred regimen for good-risk patients is 3 cycles of PEB protocol, which showed the same cure benefit as 4 cycles, but with significant reduction of toxicity. […] The preferred postorchiectomy regimen for those patients is 4 cycles of PEB protocol.

• #23 Diagnosis and treatment of relapsed and refractory testicular germ cell tumors – UpToDate

  https://www.uptodate.com/contents/diagnosis-and-treatment-of-relapsed-and-refractory-testicular-germ-cell-tumors

  Testicular germ cell tumors (GCTs) are one of the most curable solid neoplasms, with five-year survival rates in the United States of over 95 percent with contemporary treatment regimens. However, patients who relapse after first-line therapy have a substantial decrease in cure rate, with a five-year survival rate of 50 percent or lower. […] The management of relapsed or refractory testicular GCTs is complex, and patients should be referred to a cancer center with multidisciplinary expertise, and offered enrollment in clinical trials, where available. […] The management of patients with relapsed or refractory GCTs will be presented here. An overview of the initial management of patients with testicular germ cell tumors and extragonadal germ cell tumors are discussed separately. […] Systemic therapy regimens for relapsed testicular germ cell tumors: Paclitaxel, ifosfamide, and cisplatin (TIP). […] Systemic therapy regimens for relapsed germ cell tumors: Cisplatin, etoposide, and ifosfamide (VIP).

• #24 Treatment of germ cell testicular cancer

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8212650/

  After primary treatment with chemotherapy, patients with non-seminoma are evaluated with serum tumor markers and computed tomography imaging. […] The choice of first salvage treatment/second-line therapy is still a matter of debate. There are two salvage approaches, conventional-dose chemotherapy (CDCT) and HDCT followed by ASCT. […] It is known that 2.7%-8.6% of non-seminomas have non-germ cell components. […] Treatment in high-volume centers with multidisciplinary approach is crucial. […] After the introduction of cisplatin based chemotherapeutic protocols alongside advances in postchemotherapy surgical techniques and radiation, testicular cancer has become a model of curable cancer.

• #25 Chemotherapy for advanced germ cell tumors – PubMed

  https://pubmed.ncbi.nlm.nih.gov/17158534/

  Standard therapy for good-risk patients is four cycles of etoposide plus cisplatin or three cycles of cisplatin, etoposide plus bleomycin (BEP x 3); both approaches cure approximately 90% of patients. After chemotherapy and normalization of markers, patients should generally undergo resection of residual masses. Approximately 75% of intermediate-risk and 45% of poor-risk patients group achieve a durable complete response with BEP x 4. Potentially curative options in the salvage setting include ifosfamide plus cisplatin-containing standard dose therapy and high-dose carboplatin plus stem-cell rescue. Surgery remains an essential component of care. […] Curative therapy exists even in patients with resistant disease, and treatment choices can be based on established clinical criteria. Serum tumor markers and surgery after chemotherapy have essential roles in patient management.

• #26 Germ Cell Tumor Treatment | Mya Care

  https://myacare.com/procedure/germ-cell-tumor-treatment

  Childhood central nervous system (CNS) germ cell tumors form from germ cells. […] There are different types of treatment for patients with childhood central nervous system (CNS) germ cell tumors. […] Children with childhood CNS germ cell tumors should have their treatment planned by a team of health care providers who are experts in treating cancer in children. […] Four types of treatment are used: Radiation therapy, Chemotherapy, Surgery, High-dose chemotherapy with stem cell rescue. […] Treatment of newly diagnosed central nervous system (CNS) germinomas may include the following: Radiation therapy to the tumor and ventricles (fluid-filled spaces) of the brain. […] Treatment of newly diagnosed mature and immature central nervous system (CNS) teratomas may include the following: Surgery to remove as much of the tumor as possible. […] Treatment of recurrent childhood central nervous system (CNS) germ cell tumors may include the following: Chemotherapy followed by radiation therapy.

• #27 Extragonadal Germ Cell Tumors Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/278174-treatment

  Treatment modality is determined by the site and the histologic type of the primary tumor. Seminomas are very sensitive to chemotherapy and radiotherapy. Nonseminomatous germ cell tumors (NS-GCTs) are less sensitive to these modalities and may require surgery for resection of a postchemotherapy residual mass. Prior to the availability of cisplatin-based chemotherapy, cure rates for nonseminomatous germ cell tumors were less than 10%. Mature teratomas are relatively insensitive to both chemotherapy and radiation therapy; therefore surgery is the only treatment. […] Studies of immunotherapy (eg, with immune checkpoint inhibitors) have yielded inconsistent results in extragonadal germ cell tumors. Considerable further research will be needed before immunotherapy can enter clinical practice in this setting.

• #28 Extragonadal Germ Cell Tumors Treatment – NCI

  https://www.cancer.gov/types/extragonadal-germ-cell/patient/extragonadal-treatment-pdq

  The following types of treatment are used: Radiation therapy, Chemotherapy, Surgery. […] Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. External radiation therapy is used to treat seminoma. […] Chemotherapy (also called chemo) uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. […] If you have benign tumors or tumor remaining after chemotherapy or radiation therapy, surgery may be needed. […] Treatment of seminoma extragonadal germ cell tumors may include: Radiation therapy for small tumors in one area, followed by watchful waiting if there is tumor remaining after treatment. Chemotherapy for larger tumors or tumors that have spread. If a tumor smaller than 3 centimeters remains after chemotherapy, watchful waiting follows. If a larger tumor remains after treatment, surgery or watchful waiting follow.

• #29 Extragonadal Germ Cell Tumors Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/278174-treatment

  Cisplatin-based chemotherapy has made a significant improvement in treatment of seminoma of the mediastinum. Treatment with four cycles of bleomycin, etoposide, and cisplatin (BEP) is the current standard of care. Radiotherapy can be used after chemotherapy in bulky mediastinal seminomas. […] In nonseminomatous mediastinal germ cell tumors (NS-MGCT), four cycles of BEP are recommended. If the serum tumor markers remain elevated, give salvage chemotherapy. If the CT scan shows residual disease with or without tumor marker elevation, perform surgical resection followed by two cycles of chemotherapy. The nature of the salvage and postsurgical chemotherapy remains debated. Intensive cisplatin-based chemotherapy followed by resection of residual tumor was shown to yield survival rates of 48-73% in nonseminomatous mediastinal germ cell tumors.

• #30 Extragonadal Germ Cell Tumors Treatment – NCI

  https://www.cancer.gov/types/extragonadal-germ-cell/patient/extragonadal-treatment-pdq

  Extragonadal germ cell tumors can be benign (noncancer) or malignant (cancer). Benign extragonadal germ cell tumors are called benign teratomas. These are more common than malignant extragonadal germ cell tumors and often are very large. […] Malignant extragonadal germ cell tumors are divided into two types, nonseminoma and seminoma. Nonseminomas tend to grow and spread more quickly than seminomas. They usually are large and cause signs and symptoms. If untreated, malignant extragonadal germ cell tumors may spread to the lungs, lymph nodes, bones, liver, or other parts of the body. […] Different types of treatments are available for extragonadal germ cell tumors. You and your cancer care team will work together to decide your treatment plan, which may include more than one type of treatment. Many factors will be considered, such as the tumor’s prognostic group, your overall health, and your preferences. Your plan will include information about your cancer, the goals of treatment, your treatment options and the possible side effects, and the expected length of treatment.

• #31 Extragonadal Germ Cell Tumors Treatment – NCI

  https://www.cancer.gov/types/extragonadal-germ-cell/patient/extragonadal-treatment-pdq

  Treatment of nonseminoma extragonadal germ cell tumors may include: Combination chemotherapy followed by surgery to remove any remaining tumor. […] Treatment of extragonadal germ cell tumors that are recurrent (come back after being treated) or refractory (do not get better during treatment) may include: chemotherapy, a clinical trial of high-dose chemotherapy with stem cell transplant.

• #32 Extragonadal Germ Cell Tumors Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/278174-treatment

  Cisplatin-based chemotherapy has made a significant improvement in treatment of seminoma of the mediastinum. Treatment with four cycles of bleomycin, etoposide, and cisplatin (BEP) is the current standard of care. Radiotherapy can be used after chemotherapy in bulky mediastinal seminomas. […] In nonseminomatous mediastinal germ cell tumors (NS-MGCT), four cycles of BEP are recommended. If the serum tumor markers remain elevated, give salvage chemotherapy. If the CT scan shows residual disease with or without tumor marker elevation, perform surgical resection followed by two cycles of chemotherapy. The nature of the salvage and postsurgical chemotherapy remains debated. Intensive cisplatin-based chemotherapy followed by resection of residual tumor was shown to yield survival rates of 48-73% in nonseminomatous mediastinal germ cell tumors.

• #33 Extragonadal Germ Cell Tumors Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/278174-treatment

  No further chemotherapy is recommended if the final pathology is consistent with mature teratoma or necrotic tissue. Additional postoperative chemotherapy is given if the patient is found to have viable tumors. Although the same chemotherapy used preoperatively may be used after surgery, it is reasonable to switch to another drug combination.

• #34 Treatment of Ovarian Germ Cell Tumors – NCI

  https://www.cancer.gov/types/ovarian/patient/ovarian-germ-cell-treatment-pdq

  Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. […] High-dose chemotherapy with bone marrow transplant is a method of giving very high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. […] Treatment of dysgerminoma may include: Unilateral salpingo-oophorectomy with or without lymphangiography or CT scan, Unilateral salpingo-oophorectomy followed by observation, Unilateral salpingo-oophorectomy followed by radiation therapy, Unilateral salpingo-oophorectomy followed by chemotherapy. […] Treatment of other ovarian germ cell tumors may include: unilateral salpingo-oophorectomy followed by careful observation; or unilateral salpingo-oophorectomy, sometimes followed by combination chemotherapy.

• #35 Treatment of Ovarian Germ Cell Tumors – NCI

  https://www.cancer.gov/types/ovarian/patient/ovarian-germ-cell-treatment-pdq

  Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. […] High-dose chemotherapy with bone marrow transplant is a method of giving very high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. […] Treatment of dysgerminoma may include: Unilateral salpingo-oophorectomy with or without lymphangiography or CT scan, Unilateral salpingo-oophorectomy followed by observation, Unilateral salpingo-oophorectomy followed by radiation therapy, Unilateral salpingo-oophorectomy followed by chemotherapy. […] Treatment of other ovarian germ cell tumors may include: unilateral salpingo-oophorectomy followed by careful observation; or unilateral salpingo-oophorectomy, sometimes followed by combination chemotherapy.

• #36 Treatment of Ovarian Germ Cell Tumors – NCI

  https://www.cancer.gov/types/ovarian/patient/ovarian-germ-cell-treatment-pdq

  Treatment of dysgerminoma may include: total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by radiation therapy or combination chemotherapy; or unilateral salpingo-oophorectomy followed by chemotherapy. […] Treatment of other ovarian germ cell tumors may include: Unilateral salpingo-oophorectomy followed by combination chemotherapy, Second-look laparotomy (surgery done after primary treatment to see if tumor cells remain), A clinical trial of a new treatment. […] Treatment of dysgerminoma may include: Total abdominal hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible. […] Treatment of other ovarian germ cell tumors may include: Total abdominal hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible. Chemotherapy will be given before and/or after surgery.

• #37 Treatment of Ovarian Germ Cell Tumors – NCI

  https://www.cancer.gov/types/ovarian/patient/ovarian-germ-cell-treatment-pdq

  Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. […] High-dose chemotherapy with bone marrow transplant is a method of giving very high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. […] Treatment of dysgerminoma may include: Unilateral salpingo-oophorectomy with or without lymphangiography or CT scan, Unilateral salpingo-oophorectomy followed by observation, Unilateral salpingo-oophorectomy followed by radiation therapy, Unilateral salpingo-oophorectomy followed by chemotherapy. […] Treatment of other ovarian germ cell tumors may include: unilateral salpingo-oophorectomy followed by careful observation; or unilateral salpingo-oophorectomy, sometimes followed by combination chemotherapy.

• #38 Treatment of Ovarian Germ Cell Tumors – NCI

  https://www.cancer.gov/types/ovarian/patient/ovarian-germ-cell-treatment-pdq

  Treatment of dysgerminoma may include: total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by radiation therapy or combination chemotherapy; or unilateral salpingo-oophorectomy followed by chemotherapy. […] Treatment of other ovarian germ cell tumors may include: Unilateral salpingo-oophorectomy followed by combination chemotherapy, Second-look laparotomy (surgery done after primary treatment to see if tumor cells remain), A clinical trial of a new treatment. […] Treatment of dysgerminoma may include: Total abdominal hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible. […] Treatment of other ovarian germ cell tumors may include: Total abdominal hysterectomy and bilateral salpingo-oophorectomy, with removal of as much of the cancer in the pelvis and abdomen as possible. Chemotherapy will be given before and/or after surgery.

• #39 Ovarian Germ Cell Tumor Treatment | Ovarian Teratoma Treatment | American Cancer Society

  https://www.cancer.org/cancer/types/ovarian-cancer/treating/germ-cell-tumors.html

  If dysgerminoma is limited to one ovary, surgery to remove that ovary and the fallopian tube on the same side might be the only treatment needed, without chemo after surgery. This approach requires close follow-up so that if the cancer comes back it can be found early and treated. Most women in this stage are cured with surgery and never need chemo. […] A grade 1 immature teratoma is made up mostly of non-cancerous tissue, and only a few cancerous areas are seen. These tumors rarely come back after being removed. If careful staging has determined that a grade 1 immature teratoma is limited to one or both ovaries, surgery to remove the ovary or ovaries containing the cancer and the fallopian tube or tubes might be the only treatment needed. […] Treatment for recurrent or persistent germ cell tumors might include surgery, chemo or, rarely, radiation therapy. For chemo, a combination of drugs is used most often. PEB (cisplatin, etoposide, and bleomycin) may be used if this combination of drugs was not used before. For women who have already been treated with PEB, other drug combinations are used. […] For recurrent or persistent germ cell cancer, a clinical trial for new treatments may provide important advantages.

• #40 Ovarian Dysgerminomas: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/2156882-overview

  If metastatic disease is identified at laparotomy, debulking should be undertaken with a goal of complete surgical cytoreduction. […] Patients with completely resected stage Ib and Ic tumors should receive 3 cycles of BEP (bleomycin, etoposide, platinum), and those with completely resected stage II-IV tumors should receive 4 cycles of BEP. Patients with bulky residual disease may require additional cycles. […] The BEP protocol is generally preferred because of its high cure rates and favorable toxicity profile. […] Alternative chemotherapy regimens are as follows: Methotrexate, actinomycin D, and chlorambucil (MAC); Cisplatin, vincristine, and bleomycin (PVB); Vincristine, actinomycin D, and cyclophosphamide (VAC).

• #41 Childhood Germ Cell Tumor of the Brain | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/childhood-germ-cell-tumor-of-the-brain

  Germ cell tumors that develop in the brain or spinal cord are also called CNS (central nervous system) germ cell tumors. […] At Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, your child will receive care at one of the largest and most experienced pediatric brain tumor treatment programs in the world. Within the Childhood Brain Tumor Center, our specialists have extensive expertise in treating all types of brain tumors, including germ cell tumors. […] Successfully treating your child’s germ cell tumor depends on identifying the tumor type and location. We classify germ cell tumors of the brain into two main types: Germinomas: These are pure germ cell tumors. They respond well to treatment. Non-germinomatous tumors: These tumors secrete chemicals into the spinal fluid and bloodstream. They require more intensive treatment than germinomas.

• #42 Childhood Germ Cell Tumor of the Brain | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/childhood-germ-cell-tumor-of-the-brain

  Germ cell tumors that develop in the brain or spinal cord are also called CNS (central nervous system) germ cell tumors. […] At Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, your child will receive care at one of the largest and most experienced pediatric brain tumor treatment programs in the world. Within the Childhood Brain Tumor Center, our specialists have extensive expertise in treating all types of brain tumors, including germ cell tumors. […] Successfully treating your child’s germ cell tumor depends on identifying the tumor type and location. We classify germ cell tumors of the brain into two main types: Germinomas: These are pure germ cell tumors. They respond well to treatment. Non-germinomatous tumors: These tumors secrete chemicals into the spinal fluid and bloodstream. They require more intensive treatment than germinomas.

• #43 Germ Cell Brain Tumor Treatment | St. Jude Care & Treatment

  https://www.stjude.org/care-treatment/treatment/childhood-cancer/brain-tumors/germ-cell-tumors-brain.html

  Most germ cell tumors are treated with chemotherapy along with radiation therapy. […] Chemotherapy (chemo) uses powerful medicines to kill cancer cells or stop them from spreading. […] Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or stop them from growing. […] Surgery to diagnose the tumor type (biopsy) and to remove all or part of the tumor is needed in certain situations. Your oncologist will discuss with you the role of surgery. […] Our brain tumor clinical trials have led to better therapies in children. These improvements include lower-dose therapies, targeted therapy, and proton therapy. These treatments kill cancer cells while sparing healthy cells and may lessen the severity of side effects that affect brain function after treatment for some types of brain tumors.

• #44 Childhood Germ Cell Tumor of the Brain | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/childhood-germ-cell-tumor-of-the-brain

  After we complete all diagnostic testing, a team of pediatric tumor experts comes together to decide on the best treatment plan for your child. We meet with you and your family to discuss our treatment recommendations and answer any questions. […] Your child’s treatment plan will depend on their age, health, and medical history, as well as the tumors characteristics. […] Treatments we offer include: […] Surgery: We initially use surgery to biopsy the tumor and form a complete diagnosis. Depending on the germ cell tumor type, we may recommend further surgery to remove as much of the tumor as possible. […] Chemotherapy: Chemotherapy treatment involves medications that interfere with a cancer cells ability to grow or reproduce. Doctors use it to shrink tumors and eliminate remaining cancer cells.

• #45 Central Nervous System Germ Cell Tumors Treatment | NY | Montefiore Einstein Comprehensive Cancer Center

  https://montefioreeinstein.org/cancer/types/childhood/central-nervous-system-germ-cell-tumors-treatment

  High doses of chemotherapy are given to kill cancer cells. Healthy cells, including blood-forming cells, are also destroyed by the cancer treatment. Stem cell transplant is a treatment to replace the blood-forming cells. […] New types of treatment are being tested in clinical trials. […] Treatment for childhood CNS germ cell tumors may cause side effects. […] For some patients, taking part in a clinical trial may be the best treatment choice. […] Patients can enter clinical trials before, during, or after starting their cancer treatment. […] Follow-up care may be needed. […] Treatment of newly diagnosed central nervous system (CNS) germinomas may include: Chemotherapy followed by radiation therapy, Radiation therapy to the whole brain including the ventricles (fluid-filled spaces of the brain) and spinal cord. […] Treatment of recurrent childhood central nervous system (CNS) germ cell tumors may include: Chemotherapy followed by radiation therapy, for germinomas.

• #46 Childhood Germ Cell Tumor of the Brain | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/childhood-germ-cell-tumor-of-the-brain

  Radiation therapy: Doctors may use radiation therapy, which involves using high-energy waves to shrink tumors or damage and destroy cancer cells. […] Children with germ cell tumors of the brain receive ongoing care in our pediatric cancer survivorship programs, including the Stop Shop Family Pediatric Neuro-Oncology Outcomes Clinic for pediatric brain tumor survivors. […] The prognosis for children with germ cells tumor of the brain largely depends on the type of tumor. Germinomas are cured in more than 90 percent of cases with combined treatment. Non-germinomatous germ cell tumors have a 65 to 85 percent cure rate, depending on their spread at diagnosis. Mixed germ cell tumors of the brain are generally more challenging to treat.

• #47 Germ Cell Tumors (Solid Tumor) Treatment | St. Jude Care & Treatment

  https://www.stjude.org/care-treatment/treatment/childhood-cancer/solid-tumors/germ-cell-tumors-solid-tumor.html

  Germ cell tumor treatment […] Surgeons try to remove all of the germ cell tumors. Chemotherapy (chemo) is used to kill any cancer cells that are left. Chemo also stops cancer cells from growing. […] St. Jude offers clinical trials and cancer research studies for children, teens, and young adults with germ cell tumors. […] The purpose of this study is to find out if accelerated chemotherapy will treat germ cell tumors as well as standard. We will also see if both treatments have similar side effects and are well tolerated. […] St. Jude provides the highest quality of care for patients with germ cell tumors: The medical team works closely with lab researchers to bring new treatments from the lab to the clinic. Ongoing research is focused on shortening how long patients receive chemo. The goal is to keep excellent survival rates but reduce the risk of long-term side effects.

• #48 Germ Cell Tumors (Solid Tumor) Treatment | St. Jude Care & Treatment

  https://www.stjude.org/care-treatment/treatment/childhood-cancer/solid-tumors/germ-cell-tumors-solid-tumor.html

  Germ cell tumor treatment […] Surgeons try to remove all of the germ cell tumors. Chemotherapy (chemo) is used to kill any cancer cells that are left. Chemo also stops cancer cells from growing. […] St. Jude offers clinical trials and cancer research studies for children, teens, and young adults with germ cell tumors. […] The purpose of this study is to find out if accelerated chemotherapy will treat germ cell tumors as well as standard. We will also see if both treatments have similar side effects and are well tolerated. […] St. Jude provides the highest quality of care for patients with germ cell tumors: The medical team works closely with lab researchers to bring new treatments from the lab to the clinic. Ongoing research is focused on shortening how long patients receive chemo. The goal is to keep excellent survival rates but reduce the risk of long-term side effects.

• #49 Germ cell tumor – Wikipedia

  https://en.wikipedia.org/wiki/Germ_cell_tumor

  Patients with advanced or high-risk GCT may need to be treated with combination chemotherapy. […] The chemotherapy regimen most commonly used in GCTs is called PEB (or BEP), and consists of bleomycin, etoposide, and a platinum-based antineoplastic (cisplatin). […] Targeted treatments, such as immunotherapy, hormonal therapy and kinase inhibitors, are being evaluated for tumors that do not respond to chemotherapy.

• #50 Extragonadal Germ Cell Tumors Treatment – NCI

  https://www.cancer.gov/types/extragonadal-germ-cell/patient/extragonadal-treatment-pdq

  Treatment of nonseminoma extragonadal germ cell tumors may include: Combination chemotherapy followed by surgery to remove any remaining tumor. […] Treatment of extragonadal germ cell tumors that are recurrent (come back after being treated) or refractory (do not get better during treatment) may include: chemotherapy, a clinical trial of high-dose chemotherapy with stem cell transplant.

• #51 Management of Testicular Germ Cell Tumors – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/april-2023/management-of-testicular-germ-cell-tumors/

  The standard treatment is 4 cycles of BEP. […] For patients in whom bleomycin is contraindicated, etoposide, ifosfamide, and cisplatin (VIP) is an alternative regimen resulting in similar OS and PFS in both intermediate- and poor-risk disease. […] The combination of gemcitabine, oxaliplatin, and paclitaxel was shown to have efficacy in cisplatin-refractory disease or relapse after HDCT with ASCT. […] The efficacy of checkpoint inhibitors for relapsed/refractory GCTs is disappointing. […] Personalized treatment of refractory GCTs based on molecular or genomic profiling has thus far been disappointing because targetable mutations are rarely identified; further studies in this area are needed to develop effective targeted therapies for patients with testis cancer.

• #52 Management of Testicular Germ Cell Tumors – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/april-2023/management-of-testicular-germ-cell-tumors/

  The standard treatment is 4 cycles of BEP. […] For patients in whom bleomycin is contraindicated, etoposide, ifosfamide, and cisplatin (VIP) is an alternative regimen resulting in similar OS and PFS in both intermediate- and poor-risk disease. […] The combination of gemcitabine, oxaliplatin, and paclitaxel was shown to have efficacy in cisplatin-refractory disease or relapse after HDCT with ASCT. […] The efficacy of checkpoint inhibitors for relapsed/refractory GCTs is disappointing. […] Personalized treatment of refractory GCTs based on molecular or genomic profiling has thus far been disappointing because targetable mutations are rarely identified; further studies in this area are needed to develop effective targeted therapies for patients with testis cancer.

• #53 Germ cell Cancer: Causes, Risk Factors, Treatment, and More

  https://www.healthline.com/health/cancer/germ-cell-cancer

  Germ cell cancer can develop in children and adults. […] Germ cell tumors are abnormal growths that form in the cells that become eggs or sperm. […] According to the National Cancer Institute, three standard treatments are used for extragonadal tumors: surgery, radiation therapy, and chemotherapy. […] Five types of standard treatments are used to treat testicular cancer: surgery, radiation therapy, chemotherapy, observation, and high-dose chemotherapy with stem cell transplant. […] Treatment options for people with ovarian germ cell cancer includes: surgery, chemotherapy, radiation therapy, and high-dose chemotherapy with bone marrow transplant. […] In children, standard treatment for germ cell cancers not in the head include: surgery, observation, and chemotherapy. […] Clinical trials are examining: targeted therapy, radiation therapy, and high dose chemotherapy with stem cell transplant. […] Your outlook with germ cell cancer depends on which type of cancer you have. Many types have high survival rates and can be managed with treatments such as chemotherapy, surgery, or radiation therapy.

• #54 Germ cell tumours | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-children/germ-cell-tumours/

  Treatment of malignant germ cell tumours in the brain is a little different. Although they are very sensitive to chemotherapy, treatment with radiotherapy is also needed. Radiotherapy is the use of high-energy rays to destroy cancer cells. Unlike germ cell tumours elsewhere in the body, its not always necessary to remove germ cell tumours in the brain with surgery. […] Treatment often causes side effects, and your childs doctor will discuss these with you before treatment starts. […] The side effects of chemotherapy usually gradually improve when treatment is over and many of them can be well controlled. […] A small number of children may develop long-term side effects of treatment, sometimes many years later. These are not common but may include problems with how the kidneys or lungs work and some hearing loss.

• #55 Germ cell tumours | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-children/germ-cell-tumours/

  Treatment of malignant germ cell tumours in the brain is a little different. Although they are very sensitive to chemotherapy, treatment with radiotherapy is also needed. Radiotherapy is the use of high-energy rays to destroy cancer cells. Unlike germ cell tumours elsewhere in the body, its not always necessary to remove germ cell tumours in the brain with surgery. […] Treatment often causes side effects, and your childs doctor will discuss these with you before treatment starts. […] The side effects of chemotherapy usually gradually improve when treatment is over and many of them can be well controlled. […] A small number of children may develop long-term side effects of treatment, sometimes many years later. These are not common but may include problems with how the kidneys or lungs work and some hearing loss.

• #56 Germ Cell Cancer and Gonadal Tumours | Children with Cancer UK

  http://www.childrenwithcancer.org.uk/childhood-cancer-info/cancer-types/germ-cell-tumours/

  The possible side effects of chemotherapy depend upon the drugs used but may include nausea and vomiting, hair loss, reduced resistance to infection, bruising and bleeding, tiredness and diarrhoea. […] A number of children may develop persistent side effects as a result of treatment, sometimes many years later, these are known as late effects. These can include a reduction in normal bone growth, reduced fertility, a change in heart function, a small increase in the risk of developing a second cancer later in life. […] Surgery and radiotherapy may both cause functional or cosmetic problems depending on the area of the body in which the tumour occurred. Removal of a single ovary or testis should not affect a child’s future ability to have children. […] Chemotherapy may cause problems with heart and kidney function, fertility problems and a small increase in risk of developing another cancer. […] The treatment and prognosis for relapsed disease will depend on a number of factors including the site of relapse.

• #57 Treatment of Germ Cell Tumors and Sex Cord Stromal Tumors | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/pediatrics/cancer-care/types/germ-cell-tumors-sex-cord-tumors/treatment

  If your child needs chemotherapy, they may get the drugs cisplatin, etoposide, and bleomycin. […] Your child may have radiation therapy if the cancer has come back. Radiation therapy uses high-energy beams to kill cancer cells. […] MSK Kids researchers have research studies, also known as clinical trials, to explore new therapies for young people with rare tumors. […] Treatments have different side effects. Your childs side effects depend on the type of treatment they had. […] If your child has chemotherapy, side effects can include nausea and vomiting, less appetite, hair loss, and mouth sores. Radiation therapy can cause skin irritation and fatigue (feeling tired). […] At MSK Kids, we try whenever possible to use treatments that have the best chance of curing the cancer with the lowest risk of late effects. […] We will keep monitoring (checking) your childs health after their treatment ends. You must come in for visits every now and then so we can be sure the tumor is gone.

• #58 Germ cell tumours | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-children/germ-cell-tumours/

  Treatment of malignant germ cell tumours in the brain is a little different. Although they are very sensitive to chemotherapy, treatment with radiotherapy is also needed. Radiotherapy is the use of high-energy rays to destroy cancer cells. Unlike germ cell tumours elsewhere in the body, its not always necessary to remove germ cell tumours in the brain with surgery. […] Treatment often causes side effects, and your childs doctor will discuss these with you before treatment starts. […] The side effects of chemotherapy usually gradually improve when treatment is over and many of them can be well controlled. […] A small number of children may develop long-term side effects of treatment, sometimes many years later. These are not common but may include problems with how the kidneys or lungs work and some hearing loss.

• #59 Germ Cell Cancer and Gonadal Tumours | Children with Cancer UK

  http://www.childrenwithcancer.org.uk/childhood-cancer-info/cancer-types/germ-cell-tumours/

  The possible side effects of chemotherapy depend upon the drugs used but may include nausea and vomiting, hair loss, reduced resistance to infection, bruising and bleeding, tiredness and diarrhoea. […] A number of children may develop persistent side effects as a result of treatment, sometimes many years later, these are known as late effects. These can include a reduction in normal bone growth, reduced fertility, a change in heart function, a small increase in the risk of developing a second cancer later in life. […] Surgery and radiotherapy may both cause functional or cosmetic problems depending on the area of the body in which the tumour occurred. Removal of a single ovary or testis should not affect a child’s future ability to have children. […] Chemotherapy may cause problems with heart and kidney function, fertility problems and a small increase in risk of developing another cancer. […] The treatment and prognosis for relapsed disease will depend on a number of factors including the site of relapse.

• #60 Treatment for testicular cancer – NHS

  https://www.nhs.uk/conditions/testicular-cancer/treatment/

  Testicular cancer is often treatable. […] The treatment you have will depend on: the size and type of testicular cancer you have, if it has spread, your general health. […] It will usually include surgery to remove the testicle. This may be your only treatment or you may also have chemotherapy or radiotherapy. […] Some treatments for testicular cancer can affect your fertility. Before you start treatment, you’ll be offered the option to collect and store your sperm (called sperm banking). […] Surgery to remove the testicle (orchidectomy) is the main treatment for testicular cancer. […] You might also have surgery to remove lymph nodes (small glands that are part of the body’s immune system) in your tummy if your cancer has or might have spread to them. […] Chemotherapy uses medicines to kill cancer cells.

• #61 Ovarian Germ Cell Tumor Treatment | Ovarian Teratoma Treatment | American Cancer Society

  https://www.cancer.org/cancer/types/ovarian-cancer/treating/germ-cell-tumors.html

  Sometimes, the doctor might consider removing only a part of one ovary to allow a woman to keep her ovarian function. Even when both ovaries need to be removed, a woman may wish to keep her uterus to allow future pregnancy through the use of in-vitro fertilization. […] If cancer has spread beyond the ovaries, debulking surgery may be done as a part of the initial surgery. This removes as much cancer as possible without damaging or removing essential organs. […] Most women with germ cell cancer will need to be treated with combination chemo for at least 3 cycles. The combination used most often is PEB (or BEP), and includes the chemo drugs cisplatin, etoposide, and bleomycin. Dysgerminomas are usually very sensitive to chemo, and can sometimes be treated with the less toxic combination of carboplatin and etoposide. Other drug combinations may be used to treat cancer that has recurred (come back) or hasn’t responded to treatment.

• #62 Get Germ Cell Tumor Treatment | Cleveland Clinic Children’s

  https://my.clevelandclinic.org/pediatrics/services/germ-cell-tumor-treatment

  Our follow-up care starts with helping your child recover after surgery, but it doesnt stop there. Well care for your child long after theyve finished treatment. Your child will continue to visit their providers regularly to see how theyre doing and to check their overall health. Well also do tests to make sure a germ cell tumor hasnt come back or there arent any signs of new health conditions that may develop after treatment. […] If your child has a germ cell tumor, youll want to work with pediatric healthcare providers who specialize in treating rare conditions. And youll want compassionate providers who understand how children and teens react to having a serious illness. Youll find that combination of expertise and compassion at Cleveland Clinic Childrens. Well develop personalized care plans that also include support for your child and you as you manage their illness and any long-term challenges.

• #63 Ovarian Dysgerminomas: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/2156882-overview

  Most ovarian dysgerminomas are stage I and thus can be treated by surgical resection alone, with a unilateral salpingo-oophorectomy and staging. Follow-up care with serial pelvic examinations and assessment of tumor markers (ie, beta-hCG, AFP, LDH) is required if resection is the only treatment. […] Reserve adjuvant therapy for women with stage Ib-IV dysgerminomas. The standard of care for these patients is platinum-based chemotherapy, which is generally well tolerated. […] Women who wish to maintain fertility should undergo exploratory laparotomy, pelvic washings, unilateral salpingo-oophorectomy, ipsilateral pelvic and bilateral para-aortic lymphadenectomy, omentectomy, and peritoneal biopsies. Those who have completed childbearing should also undergo total abdominal hysterectomy and bilateral salpingo-oophorectomy.

• #64 Recovery & Support for Germ Cell Tumors | NYU Langone Health

  https://nyulangone.org/conditions/germ-cell-tumors-in-children/support

  Our programs can support you and your child throughout treatment and recovery. […] A child who has chemotherapy or surgery for a germ cell tumor may experience fatigue and weakness. After an evaluation by a physician at NYU Langones Rusk Rehabilitation, your child may receive physical and occupational therapy, including strength training, to help increase his or her energy level. […] Wellness programs for children, their siblings, and their parents are offered daily at the Stephen D. Hassenfeld Childrens Center for Cancer and Blood Disorders. These include art therapy, horticulture therapy, massage, music therapy, pet therapy, psychological services, sibling support groups, yoga, and more. Our medical librarians, social workers, and therapists provide your family with support and information during treatment and recovery.

• #65 Treatment of Germ Cell Tumors and Sex Cord Stromal Tumors | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/pediatrics/cancer-care/types/germ-cell-tumors-sex-cord-tumors/treatment

  If your child needs chemotherapy, they may get the drugs cisplatin, etoposide, and bleomycin. […] Your child may have radiation therapy if the cancer has come back. Radiation therapy uses high-energy beams to kill cancer cells. […] MSK Kids researchers have research studies, also known as clinical trials, to explore new therapies for young people with rare tumors. […] Treatments have different side effects. Your childs side effects depend on the type of treatment they had. […] If your child has chemotherapy, side effects can include nausea and vomiting, less appetite, hair loss, and mouth sores. Radiation therapy can cause skin irritation and fatigue (feeling tired). […] At MSK Kids, we try whenever possible to use treatments that have the best chance of curing the cancer with the lowest risk of late effects. […] We will keep monitoring (checking) your childs health after their treatment ends. You must come in for visits every now and then so we can be sure the tumor is gone.

• #66 Diagnosis and treatment of relapsed and refractory testicular germ cell tumors – UpToDate

  https://www.uptodate.com/contents/diagnosis-and-treatment-of-relapsed-and-refractory-testicular-germ-cell-tumors

  Testicular germ cell tumors (GCTs) are one of the most curable solid neoplasms, with five-year survival rates in the United States of over 95 percent with contemporary treatment regimens. However, patients who relapse after first-line therapy have a substantial decrease in cure rate, with a five-year survival rate of 50 percent or lower. […] The management of relapsed or refractory testicular GCTs is complex, and patients should be referred to a cancer center with multidisciplinary expertise, and offered enrollment in clinical trials, where available. […] The management of patients with relapsed or refractory GCTs will be presented here. An overview of the initial management of patients with testicular germ cell tumors and extragonadal germ cell tumors are discussed separately. […] Systemic therapy regimens for relapsed testicular germ cell tumors: Paclitaxel, ifosfamide, and cisplatin (TIP). […] Systemic therapy regimens for relapsed germ cell tumors: Cisplatin, etoposide, and ifosfamide (VIP).

• #67 Diagnosis and treatment of relapsed and refractory testicular germ cell tumors – UpToDate

  https://www.uptodate.com/contents/diagnosis-and-treatment-of-relapsed-and-refractory-testicular-germ-cell-tumors

  Testicular germ cell tumors (GCTs) are one of the most curable solid neoplasms, with five-year survival rates in the United States of over 95 percent with contemporary treatment regimens. However, patients who relapse after first-line therapy have a substantial decrease in cure rate, with a five-year survival rate of 50 percent or lower. […] The management of relapsed or refractory testicular GCTs is complex, and patients should be referred to a cancer center with multidisciplinary expertise, and offered enrollment in clinical trials, where available. […] The management of patients with relapsed or refractory GCTs will be presented here. An overview of the initial management of patients with testicular germ cell tumors and extragonadal germ cell tumors are discussed separately. […] Systemic therapy regimens for relapsed testicular germ cell tumors: Paclitaxel, ifosfamide, and cisplatin (TIP). […] Systemic therapy regimens for relapsed germ cell tumors: Cisplatin, etoposide, and ifosfamide (VIP).

• #68 Childhood Germ Cell Tumor of the Brain | Dana-Farber Cancer Institute

  https://www.dana-farber.org/cancer-care/types/childhood-germ-cell-tumor-of-the-brain

  Radiation therapy: Doctors may use radiation therapy, which involves using high-energy waves to shrink tumors or damage and destroy cancer cells. […] Children with germ cell tumors of the brain receive ongoing care in our pediatric cancer survivorship programs, including the Stop Shop Family Pediatric Neuro-Oncology Outcomes Clinic for pediatric brain tumor survivors. […] The prognosis for children with germ cells tumor of the brain largely depends on the type of tumor. Germinomas are cured in more than 90 percent of cases with combined treatment. Non-germinomatous germ cell tumors have a 65 to 85 percent cure rate, depending on their spread at diagnosis. Mixed germ cell tumors of the brain are generally more challenging to treat.

• #69

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