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Published on: March 7, 2017
Paediatric extracranial germ-cell tumours
Furqan Shaikh1, Matthew J Murray2, James F Amatruda3
1Division of Haematology and Oncology, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada.
Insights
Managing paediatric extracranial germ-cell tumours presents unique challenges due to their heterogeneity. Improving outcomes requires better risk stratification, biomarkers, and international collaboration for all patients.
Area of Science:
- Oncology
- Paediatric Medicine
- Cancer Research
Background:
- Paediatric extracranial germ-cell tumours are a diverse group of neoplasms with varied presentations and behaviors.
- Management is complex due to differences between paediatric, adolescent, and adult disease, requiring specialized care.
- Current treatment approaches have evolved disparately, leading to suboptimal outcomes for certain patient groups.
Purpose of the Study:
- To highlight the unique challenges in managing paediatric extracranial germ-cell tumours.
- To identify patient groups with suboptimal outcomes and significant long-term toxicities.
- To outline future directions for improving patient care and outcomes through research and collaboration.
Main Methods:
- This study is a review and synthesis of current knowledge on paediatric extracranial germ-cell tumours.
- It analyzes the complexities in staging, risk stratification, and treatment.
- It discusses the impact of molecular studies and collaborative clinical data.
Main Results:
- Suboptimal outcomes persist for adolescents, extragonadal tumours, high tumour markers, and platinum-resistant disease.
- Survivors experience significant long-term toxicities.
- Current management strategies face challenges in providing age-appropriate, evidence-based care.
Conclusions:
- Future research must focus on translating molecular insights and collaborative data into improved patient outcomes.
- Enhanced risk-stratification systems and biomarkers for response and toxicity are crucial.
- International collaboration and novel therapeutic approaches are needed for poor-risk patients.
Abstract:
Management of paediatric extracranial germ-cell tumours carries a unique set of challenges. Germ-cell tumours are a heterogeneous group of neoplasms that present across a wide age range and vary in site, histology, and clinical behaviour. Patients with germ-cell tumours are managed by a diverse array of specialists. Thus, staging, risk stratification, and treatment approaches for germ-cell tumours have evolved disparately along several trajectories. Paediatric germ-cell tumours differ from the adolescent and adult disease in many ways, leading to complexities in applying age-appropriate, evidence-based care. Suboptimal outcomes remain for several groups of patients, including adolescents, and patients with extragonadal tumours, high tumour markers at diagnosis, or platinum-resistant disease. Survivors have significant long-term toxicities. The challenge moving forward will be to translate new insights from molecular studies and collaborative clinical data into improved patient outcomes. Future trials will be characterised by improved risk-stratification systems, biomarkers for response and toxic effects, rational reduction of therapy for low-risk patients and novel approaches for poor-risk patients, and improved international collaboration across paediatric and adult cooperative research groups.
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