Standard Treatment Options for Malignant Extragonadal Extracranial GCTs in Postpubertal Children

In a study of prognostic factors in pediatric extragonadal malignant GCTs, age older than 12 years was the most important prognostic factor. In a multivariate analysis, children aged 12 years and older with thoracic tumors had six times the risk of death compared with children younger than 12 years with primary nonthoracic tumors.[17] In a subsequent meta-analysis, adolescents with stage III and stage IV extragonadal disease had poor outcomes (expected EFS rate, <70%).[3] Extragonadal disease of any stage is considered a poor risk factor in adolescents and young adults.[18]

Standard treatment options for malignant extragonadal extracranial GCTs in postpubertal children include the following:

As with sacrococcygeal tumors, primary chemotherapy is usually necessary to facilitate surgical resection of mediastinal GCTs, and the completeness of resection is a very important prognostic indicator.[7,19] Survival rates for the older adolescent and young adult population with mediastinal tumors are generally lower than 60%.[3,17,20-22]; [23][Level of evidence C1]

Patients with a malignant mediastinal primary tumor and extracranial metastases are at the highest risk of developing brain metastases and are monitored closely for signs and symptoms of central nervous system involvement.[24][Level of evidence C1] For more information about the treatment of adult patients, see Extragonadal Germ Cell Tumors Treatment.