Editing Germ Cell Tumours (section)

====== Relapsing NSGCT ======

* '''Treatment depends on what treatment the patient previously received and, in certain cases, the location of the relapse.'''
* '''Chemotherapy-naïve:'''
** '''First-line chemotherapy based on ICCCG risk classification'''
** Cure rates > 95%
** Select CS I patients on surveillance who relapse in the retroperitoneum with non-bulky (<3 cm) tumor and normal serum tumor markers may be treated by induction chemotherapy or RPLND (particularly if teratoma was present in the primary tumor)
* '''Relapse after chemotherapy:'''
** '''Salvage-line chemotherapy.'''
** Patients with serologic complete response to second-line chemotherapy with residual masses should undergo surgical resection after salvage chemotherapy.
*** Patients with viable malignancy in post–salvage chemotherapy surgical specimens have a particularly poor prognosis, and their survival is not improved with the use of postoperative chemotherapy.
** In general, late relapse is resistant to chemotherapy, and the outcome is related to the ability to render patients disease-free by complete surgical resection