Impact of evidence-based interdisciplinary guidelines on testis cancer management

In 1999, interdisciplinary evidence-based guidelines were elaborated for treatment of germ cell tumors in Germany. The aims of the current study were to analyze failures in diagnosis and therapy and to demonstrate the influence of guidelines on individual therapeutic approaches and clinical outcome. Therefore, patient collectives treated before the introduction of guidelines (Group A, 1990-1999, n = 234) and those thereafter (Group B, 2000-2002, n = 84) were compared for recurrence and survival.

In both groups, medical and/or surgical treatment and clinical outcome were evaluated for therapeutic mistakes and violations of guidelines. These were analyzed for their clinical consequences.

There was no significant difference between groups concerning median age of patients or clinical stage before therapy. Altogether, 27.8% and 8.3% of all patients in Group A and B, respectively, displayed therapeutic mistakes (P < 0.005); 63% of these patients in Group A and 100% of these patients in Group B received an overtreatment. In Group A, 19/234 (8.1%) patients relapsed and 53% of these patients had been treated insufficiently (P < 0.005). Advanced disease caused the death of 3/234 patients in this study. As of this writing, only 3 of 84 (3.6%) patients in Group B have relapsed, and no patient has died because of tumor or consecutive treatment.

The integration of interdisciplinary evidence-based guidelines for treatment of testicular germ cell tumors has led to significant reduction of both overtreatment and treatment failure and/or relapse that were due to inappropriate primary therapy. Evidence-based guidelines should serve as internal quality controls in all institutions treating patients with testicular germ cell tumors.