Sabine Kliesch1, Stefanie Schmidt2, Doris Wilborn2, Clemens Aigner3, Walter Albrecht4, Jens Bedke5, Matthias Beintker6, Dirk Beyersdorff7, Carsten Bokemeyer8, Jonas Busch9, Johannes Classen10, Maike de Wit11, Klaus-Peter Dieckmann12, Thorsten Diemer13, Anette Dieing14, Matthias Gockel15, Bernt Göckel-Beining16, Oliver W Hakenberg17, Axel Heidenreich18, Julia Heinzelbecker19, Kathleen Herkommer20, Thomas Hermanns21, Sascha Kaufmann22, Marko Kornmann23, Jörg Kotzerke24, Susanne Krege25, Glen Kristiansen26, Anja Lorch27, Arndt-Christian Müller22, Karin Oechsle8, Timur Ohloff28, Christoph Oing8, Ulrich Otto29, David Pfister18, Renate Pichler30, Heinrich Recken31, Oliver Rick32, Yvonne Rudolph33, Christian Ruf34, Joachim Schirren35, Hans Schmelz36, Heinz Schmidberger37, Mark Schrader38, Stefan Schweyer39, Stefanie Seeling40, Rainer Souchon22, Christian Winter41, Christian Wittekind42, Friedemann Zengerling43, Dirk-Henrik Zermann44, Roger Zillmann45, Peter Albers27. 1. Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University Hospital Münster, Münster, Germany, kliesch@ukmuenster.de. 2. UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany. 3. Ruhrlandklinik at University Hospital Essen, Essen, Germany. 4. Department of Urology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria. 5. Department of Urology, University Hospital Tübingen, Tübingen, Germany. 6. Südharz Hospital Nordhausen gGmbH, Nordhausen, Germany. 7. Clinic and Polyclinic for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 8. II. Medical Clinic and Polyclinic, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 9. Department of Urology, Charité University Hospital, Berlin, Germany. 10. Department of Radiotherapy, Radiological Oncology and Palliative Medicine, St. Vincentius-Kliniken, Karlsruhe, Germany. 11. Clinic for Internal Medicine - Hematology, Oncology and Palliative Medicine, Vivantes Clinic Neukölln, Berlin, Germany. 12. Department of Urology, Asklepios Klinik Altona, Hamburg, Germany. 13. Clinic and Polyclinic for Urology, Pediatric Urology and Andrology, University Hospital Gießen, Gießen, Germany. 14. Clinic for Internal Medicine - Hematology and Oncology, Vivantes Clinics Am Urban, Berlin, Germany. 15. HELIOS Clinics Berlin-Buch, Berlin, Germany. 16. Urologist, Horn-Bad Meinberg, Germany. 17. Urological Clinic and Polyclinic, University Hospital Rostock, Rostock, Germany. 18. Department of Urology, University Hospital Cologne, Cologne, Germany. 19. Department of Urology, University Hospital Saarland, Saarbrücken, Germany. 20. Urological Clinic and Polyclinic of the Technical University of Munich, Munich, Germany. 21. Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 22. Department for Radiooncology, University Hospital Tübingen, Tübingen, Germany. 23. Clinic for General and Visceral Surgery, University Hospital Ulm, Ulm, Germany. 24. Klinik und Poliklinik für Nuklearmedizin, University Hospital Dresden, Dresden, Germany. 25. KEM, Protestant Hospital Essen-Mitte, Clinic for Urology, Pediatric Urology and Urological Oncology, Essen, Germany. 26. Institute of Pathology, University Hospital Bonn, Bonn, Germany. 27. Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany. 28. Advisor, German Foundation for Young Adults with Cancer, Berlin, Germany. 29. Urological Competence Centre for Rehabilitation, Bad Wildungen, Germany. 30. Department of Urology, Medical University Innsbruck, Innsbruck, Austria. 31. HFH, Hamburger Fern-Hochschule Studienzentrum Essen (Distance Learning University, Essen Study Centre), Essen, Germany. 32. Klinik Reinhardshöhe GmbH, Bad Wildungen, Germany. 33. German Cancer Society, Berlin, Germany. 34. Department of Urology, Bundeswehrkrankenhaus (German Federal Armed Forces Hospital), Ulm, Germany. 35. Helios Clinics, Wiesbaden, Germany. 36. Department of Urology, Bundeswehrkrankenhaus (German Federal Armed Forces Hospital), Koblenz, Germany. 37. Clinic and Polyclinic for Radiooncology and Radiotherapy, University Hospital Mainz, Mainz, Germany. 38. Helios Clinics, Berlin, Germany. 39. Clinic for Pathology, Starnberg, Germany. 40. University of Osnabrück, Campus Lingen, Osnabrück, Germany. 41. Urologie Neandertal (Regional Joint Practice), Erkrath, Germany. 42. Institute of Pathology, University Hospital Leipzig, Leipzig, Germany. 43. Department of Urology, University Hospital Ulm, Ulm, Germany. 44. Vogtland-Klinik Bad Elster, Bad Elster, Germany. 45. Urology Pankow, Berlin, Germany.
Abstract
INTRODUCTION: This is the first German evidence- and consensus-based clinical guideline on diagnosis, treatment, and follow-up on germ cell tumours (GCTs) of the testis in adult patients. We present the guideline content in two publications. Part I covers the topic's background, methods, epidemiology, classification systems, diagnostics, prognosis, and treatment recommendations for the localized stages. METHODS: An interdisciplinary panel of 42 experts including 1 patient representative developed the guideline content. Clinical recommendations and statements were based on scientific evidence and expert consensus. For this purpose, evidence tables for several review questions, which were based on systematic literature searches (last search was in March 2018) were provided. Thirty-one experts entitled to vote, rated the final clinical recommendations and statements. RESULTS: We provide 161 clinical recommendations and statements. We present information on the quality of cancer care and epidemiology and give recommendations for staging and classification as well as for diagnostic procedures. The diagnostic recommendations encompass measures for assessing the primary tumour as well as procedures for the detection of metastases. One chapter addresses prognostic factors. In part I, we separately present the treatment recommendations for germ cell neoplasia in situ, and the organ-confined stages (clinical stage I) of both seminoma and nonseminoma. CONCLUSION: Although GCT is a rare tumour entity with excellent survival rates for the localized stages, its management requires an interdisciplinary approach, including several clinical experts. Quality of care is highly related to institutional expertise and can be reassured by established online-based second-opinion boards. There are very few studies on diagnostics with good level of evidence. Treatment of metastatic GCTs must be tailored to the risk according to the International Germ Cell Cancer Collaboration Group classification after careful diagnostic evaluation. An interdisciplinary approach as well as the referral of selected patients to centres with proven experience can help achieve favourable clinical outcomes.
INTRODUCTION: This is the first German evidence- and consensus-based clinical guideline on diagnosis, treatment, and follow-up on germ cell tumours (GCTs) of the testis in adult patients. We present the guideline content in two publications. Part I covers the topic's background, methods, epidemiology, classification systems, diagnostics, prognosis, and treatment recommendations for the localized stages. METHODS: An interdisciplinary panel of 42 experts including 1 patient representative developed the guideline content. Clinical recommendations and statements were based on scientific evidence and expert consensus. For this purpose, evidence tables for several review questions, which were based on systematic literature searches (last search was in March 2018) were provided. Thirty-one experts entitled to vote, rated the final clinical recommendations and statements. RESULTS: We provide 161 clinical recommendations and statements. We present information on the quality of cancer care and epidemiology and give recommendations for staging and classification as well as for diagnostic procedures. The diagnostic recommendations encompass measures for assessing the primary tumour as well as procedures for the detection of metastases. One chapter addresses prognostic factors. In part I, we separately present the treatment recommendations for germ cell neoplasia in situ, and the organ-confined stages (clinical stage I) of both seminoma and nonseminoma. CONCLUSION: Although GCT is a rare tumour entity with excellent survival rates for the localized stages, its management requires an interdisciplinary approach, including several clinical experts. Quality of care is highly related to institutional expertise and can be reassured by established online-based second-opinion boards. There are very few studies on diagnostics with good level of evidence. Treatment of metastatic GCTs must be tailored to the risk according to the International Germ Cell Cancer Collaboration Group classification after careful diagnostic evaluation. An interdisciplinary approach as well as the referral of selected patients to centres with proven experience can help achieve favourable clinical outcomes.
Authors: Melissa C Brouwers; Michelle E Kho; George P Browman; Jako S Burgers; Francoise Cluzeau; Gene Feder; Béatrice Fervers; Ian D Graham; Jeremy Grimshaw; Steven E Hanna; Peter Littlejohns; Julie Makarski; Louise Zitzelsberger Journal: CMAJ Date: 2010-07-05 Impact factor: 8.262
Authors: C Albany; N Adra; A C Snavely; C Cary; T A Masterson; R S Foster; K Kesler; T M Ulbright; L Cheng; M Chovanec; F Taza; K Ku; M J Brames; N H Hanna; L H Einhorn Journal: Ann Oncol Date: 2018-02-01 Impact factor: 32.976
Authors: Jeremy F Sturgeon; Malcolm J Moore; David M Kakiashvili; Ignacio Duran; Lynn C Anson-Cartwright; Dominik R Berthold; Padraig R Warde; Mary K Gospodarowicz; Ruth E Alison; Justin Liu; Clement Ma; Greg R Pond; Michael A Jewett Journal: Eur Urol Date: 2010-12-22 Impact factor: 20.096
Authors: Christian Kollmannsberger; Torgrim Tandstad; Philippe L Bedard; Gabriella Cohn-Cedermark; Peter W Chung; Michael A Jewett; Tom Powles; Padraig R Warde; Siamak Daneshmand; Andrew Protheroe; Scott Tyldesley; Peter C Black; Kim Chi; Alan I So; Malcom J Moore; Craig R Nichols Journal: J Clin Oncol Date: 2014-08-18 Impact factor: 44.544
Authors: Christian G Ruf; Hendrik Isbarn; Walter Wagner; Margit Fisch; Cord Matthies; Klaus-Peter Dieckmann Journal: Urol Oncol Date: 2013-02-06 Impact factor: 3.498
Authors: Penny F Whiting; Anne W S Rutjes; Marie E Westwood; Susan Mallett; Jonathan J Deeks; Johannes B Reitsma; Mariska M G Leeflang; Jonathan A C Sterne; Patrick M M Bossuyt Journal: Ann Intern Med Date: 2011-10-18 Impact factor: 25.391
Authors: Sabine Kliesch; Stefanie Schmidt; Doris Wilborn; Clemens Aigner; Walter Albrecht; Jens Bedke; Matthias Beintker; Dirk Beyersdorff; Carsten Bokemeyer; Jonas Busch; Johannes Classen; Maike de Wit; Klaus-Peter Dieckmann; Thorsten Diemer; Anette Dieing; Matthias Gockel; Bernt Göckel-Beining; Oliver W Hakenberg; Axel Heidenreich; Julia Heinzelbecker; Kathleen Herkommer; Thomas Hermanns; Sascha Kaufmann; Marko Kornmann; Jörg Kotzerke; Susanne Krege; Glen Kristiansen; Anja Lorch; Arndt-Christian Müller; Karin Oechsle; Timur Ohloff; Christoph Oing; Ulrich Otto; David Pfister; Renate Pichler; Heinrich Recken; Oliver Rick; Yvonne Rudolph; Christian Ruf; Joachim Schirren; Hans Schmelz; Heinz Schmidberger; Mark Schrader; Stefan Schweyer; Stefanie Seeling; Rainer Souchon; Christian Winter; Christian Wittekind; Friedemann Zengerling; D H Zermann; Roger Zillmann; Peter Albers Journal: Urol Int Date: 2021-01-22 Impact factor: 2.089
Authors: Stefanie Schmidt; Carsten Bokemeyer; Christian Winter; Friedemann Zengerling; Jonas Busch; Julia Heinzelbecker; David Pfister; Christian Ruf; Julia Lackner; Peter Albers; Sabine Kliesch Journal: World J Urol Date: 2022-05-12 Impact factor: 4.226
Authors: Friedemann Zengerling; Dirk Beyersdorff; Jonas Busch; Julia Heinzelbecker; David Pfister; Christian Ruf; Christian Winter; Peter Albers; Sabine Kliesch; Stefanie Schmidt Journal: World J Urol Date: 2022-07-29 Impact factor: 3.661
Authors: Christian G Ruf; Stefanie Schmidt; Sabine Kliesch; Christoph Oing; David Pfister; Jonas Busch; Julia Heinzelbecker; Christian Winter; Friedemann Zengerling; Peter Albers; Karin Oechsle; Susanne Krege; Julia Lackner; Klaus-Peter Dieckmann Journal: World J Urol Date: 2022-09-15 Impact factor: 3.661
Authors: Klaus-Peter Dieckmann; Tomas Pokrivcak; Lajos Geczi; David Niehaus; Inken Dralle-Filiz; Cord Matthies; Tamas Dienes; Stefanie Zschäbitz; Pia Paffenholz; Tanja Gschliesser; Renate Pichler; Michal Mego; Pia Bader; Friedemann Zengerling; Julia Heinzelbecker; Philipp Krausewitz; Susanne Krege; Gaetano Aurilio; Cem Aksoy; Marcus Hentrich; Christoph Seidel; Péter Törzsök; Tim Nestler; Matthaeus Majewski; Andreas Hiester; Tomas Buchler; Sonia Vallet; Hana Studentova; Sandra Schönburg; Dora Niedersüß-Beke; Julia Ring; Emanuela Trenti; Axel Heidenreich; Christian Wülfing; Hendrik Isbarn; Uwe Pichlmeier; Martin Pichler Journal: Ther Adv Med Oncol Date: 2022-03-31 Impact factor: 8.168
Authors: Gamal Anton Wakileh; Christian Ruf; Axel Heidenreich; Klaus-Peter Dieckmann; Catharina Lisson; Vikas Prasad; Christian Bolenz; Friedemann Zengerling Journal: World J Urol Date: 2021-11-15 Impact factor: 4.226