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Abstract：
OBJECTIVE: We developed the first German evidence- and consensus-based clinical guideline on diagnosis, treatment, and follow-up of germ cell tumours (GCT) of the testes in adult patients. We present the guideline content in 2 separate publications. The present second part summarizes therecommendations for the treatment of advanced disease stages and for the management of follow-up and late effects.
METHODS: An interdisciplinary panel of 42 experts including 1 patient representative developed the guideline content. Clinical recommendations and statements were based on scientific evidence and expert consensus. For this purpose, evidence tables for several review questions, which were based on systematic literature searches (last search in March 2018), were provided. Thirty-one experts, who were entitled to vote, rated the final clinical recommendations and statements.
RESULTS: Here we present the treatment recommendations separately for patients with metastatic seminoma and non-seminomatous GCT (stages IIA/B and IIC/III), for restaging and treatment of residual masses, and for relapsed and refractory disease stages. The recommendations also cover extragonadal and sex cord/stromal tumours, the management of follow-up and toxicity, quality-of-life aspects, palliative care, and supportive therapy.
CONCLUSIONS: Physicians and other medical service providers who are involved in the diagnostics, treatment, and follow-up of GCT (all stages, outpatient and inpatient care as well as rehabilitation) are the users of the present guideline. The guideline also comprises quality indicators for measuring the implementation of the guideline recommendations in routine clinical care; these data will be presented in a future publication.
METHODS: An interdisciplinary panel of 42 experts including 1 patient representative developed the guideline content. Clinical recommendations and statements were based on scientific evidence and expert consensus. For this purpose, evidence tables for several review questions, which were based on systematic literature searches (last search in March 2018), were provided. Thirty-one experts, who were entitled to vote, rated the final clinical recommendations and statements.
RESULTS: Here we present the treatment recommendations separately for patients with metastatic seminoma and non-seminomatous GCT (stages IIA/B and IIC/III), for restaging and treatment of residual masses, and for relapsed and refractory disease stages. The recommendations also cover extragonadal and sex cord/stromal tumours, the management of follow-up and toxicity, quality-of-life aspects, palliative care, and supportive therapy.
CONCLUSIONS: Physicians and other medical service providers who are involved in the diagnostics, treatment, and follow-up of GCT (all stages, outpatient and inpatient care as well as rehabilitation) are the users of the present guideline. The guideline also comprises quality indicators for measuring the implementation of the guideline recommendations in routine clinical care; these data will be presented in a future publication.
摘要：
目的：我们制定了第一个基于德国证据和共识的诊断临床指南，治疗,和成年患者睾丸生殖细胞肿瘤（GCT）的随访。我们在两个单独的出版物中介绍了指南内容。第二部分总结了对晚期疾病阶段的治疗以及随访和后期效果的管理的建议。
方法：由包括1名患者代表在内的42名专家组成的跨学科小组制定了指南内容。临床建议和陈述基于科学证据和专家共识。为此,几个复习问题的证据表，这是基于系统的文献检索（最后一次检索是在2018年3月），提供了。31位专家,有权投票的人，对最终临床建议和声明进行评级。
结果：在这里，我们分别提出转移性精原细胞瘤和非精原细胞瘤GCT（IIA/B和IIC/III期）患者的治疗建议。用于残余肿块的重新分类和治疗，以及复发和难治性疾病阶段。这些建议还涵盖性腺外和性索/基质肿瘤，随访和毒性的管理，生活质量方面，姑息治疗,和支持性治疗。
结论：参与诊断的医师和其他医疗服务提供者，治疗,以及GCT的随访(所有阶段，门诊和住院护理以及康复）是本指南的使用者。该指南还包括质量指标，用于衡量常规临床护理中指南建议的实施情况；这些数据将在未来的出版物中提供。
方法：由包括1名患者代表在内的42名专家组成的跨学科小组制定了指南内容。临床建议和陈述基于科学证据和专家共识。为此,几个复习问题的证据表，这是基于系统的文献检索（最后一次检索是在2018年3月），提供了。31位专家,有权投票的人，对最终临床建议和声明进行评级。
结果：在这里，我们分别提出转移性精原细胞瘤和非精原细胞瘤GCT（IIA/B和IIC/III期）患者的治疗建议。用于残余肿块的重新分类和治疗，以及复发和难治性疾病阶段。这些建议还涵盖性腺外和性索/基质肿瘤，随访和毒性的管理，生活质量方面，姑息治疗,和支持性治疗。
结论：参与诊断的医师和其他医疗服务提供者，治疗,以及GCT的随访(所有阶段，门诊和住院护理以及康复）是本指南的使用者。该指南还包括质量指标，用于衡量常规临床护理中指南建议的实施情况；这些数据将在未来的出版物中提供。
