Childhood Extracranial Germ Cell Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment of Malignant Gonadal GCTs in Children
Stages II through IV
Surgery and chemotherapy with four cycles of standard PEB is a common treatment regimen. Patients treated with this regimen have an overall survival (OS) outcome greater than 90%, suggesting that a reduction in therapy could be considered.[9,10]
Surgery and treatment with four to six cycles of carboplatin, etoposide, and bleomycin (JEB) is an alternative treatment regimen.
Evidence (surgery and chemotherapy for stages II-IV disease):
- A CCG/POG clinical trial evaluated boys younger than 10 years with stage II tumors who were treated with four cycles of PEB after diagnosis.
- The 6-year EFS and OS rates were 100%.
- In the same CCG/POG clinical trial, boys and adolescents (age not limited to 10 years or younger) with stage III and stage IV testicular tumors were treated with surgical resection followed by four cycles of standard-dose or high-dose (HD)-PEB therapy.
- The 6-year survival outcome for males younger than 15 years with stage III and stage IV tumors was 100%.
- The 6-year EFS for males younger than 15 years was 100% for stage III tumors and 94% for stage IV tumors.
- The use of HD-PEB therapy did not improve the outcome for these boys but did cause increased incidence of otologic toxic effects.
- Excellent outcomes for boys with testicular GCTs using surgery and observation for stage I tumors and JEB and other cisplatin-containing chemotherapy regimens for stage II, stage III, and stage IV tumors have also been reported by European investigators.[6,8]
Malignant testicular GCTs in postpubertal males
The treatment options described above for young boys may not be strictly applicable to adolescent males (aged 15 years and older). In particular, the use of retroperitoneal lymph node dissection may play a crucial role in the evaluation of early-stage testicular GCT  and for residual disease after chemotherapy for the treatment of metastatic GCT.[12,13]
In this age group, the presence of a sarcomatous component in the primary testis GCT does not alter the prognosis; however, if a sarcomatous component is found in a metastatic lesion, survival is likely to be compromised.