Management of Germ Cell Tumours of the Testis in Adult Patients. German Clinical Practice Guideline Part I: Epidemiology, Classification, Diagnosis, Prognosis, Fertility Preservation, and Treatment Recommendations for Localized Stages
Authors: Kliesch Sabine , Schmidt Stefanie , Wilborn Doris , Aigner Clemens , Albrecht Walter , Bedke Jens , Beintker Matthias , Beyersdorff Dirk , Bokemeyer Carsten , Busch Jonas , Classen Johannes , de Wit Maike , Dieckmann Klaus-Peter , Diemer Thorsten , Dieing Anette , Gockel Matthias , Göckel-Beining Bernt , Hakenberg Oliver W. , Heidenreich Axel , Heinzelbecker Julia , Herkommer Kathleen , Hermanns Thomas , Kaufmann Sascha , Kornmann Marko , Kotzerke Jörg , Krege Susanne , Kristiansen Glen , Lorch Anja , Müller Arndt-Christian , Oechsle Karin , Ohloff Timur , Oing Christoph , Otto Ulrich , Pfister David , Pichler Renate , Recken Heinrich , Rick Oliver , Rudolph Yvonne , Ruf Christian , Schirren Joachim , Schmelz Hans , Schmidberger Heinz , Schrader Mark , Schweyer Stefan , Seeling Stefanie , Souchon Rainer , Winter Christian , Wittekind Christian , Zengerling Friedemann , Zermann Dirk-Henrik , Zillmann Roger , Albers Peter 
Published: January 2021

<b><i>Introduction:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusion:</i></b> 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.