title: Treatment and survival patterns for germ cell tumors among 13- to 24-year olds in Yorkshire, UK.
abstract: BACKGROUND
  Teenage and young adult (TYA) patient care can fall into gaps between adult and children's services. Increasingly UK TYA multi-disciplinary teams manage germ cell tumors (GCT) in locally agreed collaborations and age ranges. Patterns of care are changing rapidly. However, between disciplines protocols define different assessment and management in GCT. We aimed to document changes in incidence, treatment, and survival since 1990, to record the baseline to which future trends can be compared.
  
  
  METHODS
  Details were extracted from the UK population-based Yorkshire Specialist Cancer Register on 237 TYA aged 13-24 years diagnosed with a GCT between 1990 and 2004, followed-up until 2009. Incidence and survival patterns were assessed using Poisson and Cox regression.
  
  
  RESULTS
  Testicular (n = 190; 80%) and ovarian (n = 22; 9%) GCT were the most common malignancies, and 90% of GCT occurred aged 17-24 years. The overall incidence rate was 26.9 per million person years. Rates increased significantly by 4.0% (95% CI: 1.0-7.1%) per year on average. The most common treatment modality was surgery combined with chemotherapy (49%). Initial treatment changed significantly over time (P = 0.003) and by age (P = 0.005). There were significant differences in the management of stage 1 testicular tumors by age. Among 13- to 16-year olds, 56% were treated exclusively in adult departments. Five-year survival rates were 93-95% for gonadal GCT, and 70-75% for other sites. Survival did not differ by age (P = 0.65) or period (P = 0.41).
  
  
  CONCLUSIONS
  The age-related differences observed in the approach to GCT treatment suggest a collaborative approach to the models of care among TYA is required.
authors.affiliation: Pediatric Epidemiology Group, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, UK. r.g.feltbower@leeds.ac.uk
authors.forename: Richard G
authors.initials: RG
authors.lastname: Feltbower
authors.forename: Catherine
authors.initials: C
authors.lastname: Siller
authors.forename: Emma
authors.initials: E
authors.lastname: Woodward
authors.forename: Patricia A
authors.initials: PA
authors.lastname: McKinney
authors.forename: Susan V
authors.initials: SV
authors.lastname: Picton
authors.forename: Jonathan
authors.initials: J
authors.lastname: Joffe
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Stark
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000628:therapy; D011878:Radiotherapy; D013736:Testicular Neoplasms / Q000453:epidemiology / Q000628:therapy; D006113:United Kingdom; D013519:Urogenital Surgical Procedures; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents