Table 5. Standard Treatment Approaches for Infants and Children Younger Than 15 Years With
Germ Cell Tumors by Histology, Stage, and Primary Site
| Histology | Primary Site | Stage | Treatment |
| Mature teratoma | All sites | Localized | Surgery + Observation |
| Immature teratoma | All sites | Localized | Surgery + Observation |
| Malignant germ cell tumors | Testicular | Stage I | Surgery + Observation |
| Stages II–IVa | Surgery + PEB |
| Ovarian | Stage Ib | Surgery + PEB |
| Stages II–IV | Surgery + PEB |
| Extragonadal | Stages I–II | Surgeryc + PEB |
| Stages III–IVa | Surgeryc + PEB |
| PEB = cisplatin, etoposide, and bleomycin. |
| aPatients aged 15 years and older with stage IV testicular tumors and all patients with stages III and IV extragonadal tumors treated with PEB have suboptimal outcome and should be considered for more intensive therapies. |
| bThe role for observation after surgery has not been well established for stage I ovarian germ cell tumors and should be reserved for a clinical trial. |
| cThe role for surgery at diagnosis for extragonadal tumors is age- and site-dependent and must be individualized. Depending on the clinical setting, the appropriate surgical approach may range from no surgery (e.g., mediastinal primary tumor in a patient with a compromised airway and elevated tumor markers), to biopsy, to primary resection. In some cases, an appropriate strategy is biopsy at diagnosis followed by subsequent surgery in selected patients who have residual masses following chemotherapy. |
