Paediatric extracranial germ-cell tumours.
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.
Division of Haematology and Oncology, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada. Electronic address: furqan.shaikh@sickkids.ca.
Furqan
F
Shaikh
Department of Pathology, University of Cambridge, Cambridge, UK; Department of Paediatric Haematology and Oncology, Addenbrooke's Hospital, Cambridge, UK.
Matthew J
MJ
Murray
Department of Pediatrics, Department of Molecular Biology and Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; Gill Center for Cancer and Blood Disorders, Children's Health, Dallas, TX, USA.
James F
JF
Amatruda
Department of Pathology, University of Cambridge, Cambridge, UK; Department of Histopathology, Addenbrooke's Hospital, Hills Road, Cambridge, UK.
Nicholas
N
Coleman
Department of Paediatric Haematology and Oncology, Addenbrooke's Hospital, Cambridge, UK.
James C
JC
Nicholson
Royal Victoria Infirmary NHS Foundation Trust, Newcastle upon Tyne, UK.
Juliet P
JP
Hale
Yale University School of Medicine, New Haven, CT, USA.
Farzana
F
Pashankar
University College London Hospitals NHS Foundation Trust, London, UK.
Sara J
SJ
Stoneham
Division of Pediatric Epidemiology and Clinical Research and Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
Jenny N
JN
Poynter
Aflac Cancer and Blood Disorders Center, Emory University, Atlanta, GA, USA.
Thomas A
TA
Olson
Riley Hospital for Children, Indianapolis, IN, USA.
Deborah F
DF
Billmire
Leeds Institute of Cancer and Pathology, University of Leeds, UK.
Daniel
D
Stark
Boston Children's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.
Carlos
C
Rodriguez-Galindo
Boston Children's Hospital and Dana Farber Cancer Institute, Boston, MA, USA.
A Lindsay
AL
Frazier
D000293:Adolescent; D000328:Adult; D014408:Biomarkers, Tumor / Q000235:genetics*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D010372:Pediatrics; D017741:Survivors; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000473:pathology / Q000628:therapy*
D014408:Biomarkers, Tumor