• Furqan Shaikh, Matthew J Murray, James F Amatruda, Nicholas Coleman, James C Nicholson, Juliet P Hale, Farzana Pashankar, Sara J Stoneham, Jenny N Poynter, Thomas A Olson, Deborah F Billmire, Daniel Stark, Carlos Rodriguez-Galindo, and A Lindsay Frazier.
• Division of Haematology and Oncology, The Hospital for Sick Children and the University of Toronto, Toronto, ON, Canada. Electronic address: furqan.shaikh@sickkids.ca.
• Lancet Oncol. 2016 Apr 1; 17 (4): e149-e162.

AbstractManagement of paediatric extracranial germ-cell tumours carries a unique set of challenges. Germ-cell tumours are a heterogeneous group of neoplasms that present across a wide age range and vary in site, histology, and clinical behaviour. Patients with germ-cell tumours are managed by a diverse array of specialists. Thus, staging, risk stratification, and treatment approaches for germ-cell tumours have evolved disparately along several trajectories. Paediatric germ-cell tumours differ from the adolescent and adult disease in many ways, leading to complexities in applying age-appropriate, evidence-based care. Suboptimal outcomes remain for several groups of patients, including adolescents, and patients with extragonadal tumours, high tumour markers at diagnosis, or platinum-resistant disease. Survivors have significant long-term toxicities. The challenge moving forward will be to translate new insights from molecular studies and collaborative clinical data into improved patient outcomes. Future trials will be characterised by improved risk-stratification systems, biomarkers for response and toxic effects, rational reduction of therapy for low-risk patients and novel approaches for poor-risk patients, and improved international collaboration across paediatric and adult cooperative research groups.Copyright © 2016 Elsevier Ltd. All rights reserved.

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