Biopsy followed by chemotherapy with or without surgery (stages III and IV)

While outcomes have improved remarkably since the advent of platinum-based chemotherapy and the use of a multidisciplinary treatment approach, complete resection before chemotherapy may be possible in some patients without major morbidity.[1,5]

However, for patients with locally advanced sacrococcygeal tumors, mediastinal tumors, or large pelvic tumors, tumor biopsy followed by preoperative chemotherapy may facilitate subsequent complete tumor resection and improve ultimate patient outcome. No decrease in OS has been noted for patients with malignant extragonadal GCTs who have had delayed resection after receiving chemotherapy.[5,7-9]