Germ cell tumours of childhood and adolescence (extracranial and CNS): lines of therapy

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4 standard-of-care settings across 2 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

Line	All comers	Risk group
Early / localised	·	2
Other settings	2	·

Early / localised

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
Risk group	Low-risk malignant extracranial GCT (e.g. stage I testicular, stage I ovarian)	Complete resection followed by active surveillance with serial tumour markers and imaging; chemotherapy only for relapse (AGCT1531 stratum).	Alpha-fetoprotein (AFP)Active surveillance	COG/CCLG AGCT1531; NCI PDQ	63
Risk group	Standard- and high-risk malignant extracranial GCT	Cisplatin, etoposide and bleomycin (PEb) or carboplatin-based JEb, with surgery of residual masses; sodium thiosulfate for otoprotection; high-dose chemotherapy with stem-cell rescue at relapse.	CisplatinCarboplatinEtoposideBleomycinSodium thiosulfate (otoprotectant)Autologous stem cell transplant (high-dose therapy)	NCI PDQ; MaGIC risk classification	87

Other settings

Subgroup	Setting	Approach	Products and trials	Guideline	Evidence
All comers	CNS germinoma	Platinum-based chemotherapy followed by reduced-dose whole-ventricular radiotherapy with tumour boost (SIOP CNS GCT II, ACNS1123).	CarboplatinEtoposideIMRT / IGRT (modern external beam)Proton therapy	NCI PDQ: childhood CNS germ cell tumours	91
All comers	CNS non-germinomatous GCT	Intensive platinum-based chemotherapy, second-look surgery for residual disease, then craniospinal or whole-ventricular radiotherapy depending on response and stage.	CisplatinIfosfamideEtoposideProton therapy		81

Sequence and caution pairings

CautionApproved

Caution: bleomycin lung toxicity, especially with brentuximab or G-CSF

Bleomycin scars the lungs; combining it with brentuximab was fatal in early trials, and PET-adapted therapy now lets most patients skip it.

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.