Interdisciplinary cooperation in the treatment of complex patients with advanced testicular germ cell tumor

Testicular germ cell tumors represent the classic example of a curable solid cancer even in the metastatic stage. Cure rates are as high as 95% and 80-85% in patients with good and intermediate prognosis; even in patients with poor prognosis cure rates of 50% have been achieved by interdisciplinary collaboration of all specialties involved in the management of testis cancer. Standardization of diagnosis and therapy should be further optimized due to the recently published interdisciplinary national and European guidelines. Besides realization of standardized guidelines, treatment of patients with extensive primary disease or recurrent germ cell tumors following standard therapy requires comprehensive knowledge in conservative and surgical management, which is basically only available at specialized cancer centers. Patients with complex findings, especially if associated with a poor prognosis according to IGCCCG, should be referred to specialized tertiary referral centers at a very early stage, since the cure rates depend not only on the consideration of guidelines but also on the expertise of the attending oncologist and surgeon. When treating these patients, one has to consider that inadequately administered chemotherapy (dosage, length of cycles, number of cycles) cannot be compensated for by surgery and that inadequately performed retroperitoneal lymphadenectomy or tumor resection cannot be compensated for by chemotherapy. In any cass, suboptimal primary therapy will result in inferior cure rates and an unnecessarily increased mortality rate.