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Radiotherapy role in non-seminomatous germ cell tumors, radiobiological and technical issues of an unexplored scenario

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Abstract

Historically, non-seminomatous germ cell tumor (NSGCT) has been considered a radio-resistant disease, excluding radiotherapy (RT) from curative strategies. However, case series exploring the use of radiation treatment in this setting are often outdated, and prospective ongoing studies testing new radiotherapeutic approaches in NSGCT are lacking. Considering that tremendous advances in radiotherapy technology have enabled improved precision in RT delivery as well as dose escalation while decreasing treatment-related morbidity, we overviewed the currently available literature to explore the radiobiological basis, the technical issues, and potential strategies for implementation of RT in the management of this clinical entity. The purpose of the present overview is to provide insight for future research in this unexplored scenario. In summary, the biological rationale for RT use and potential implementation with systemic therapies exist, especially considering the advantage of new technologies, which were unavailable in the era of early literature reports. The NSGCT radioresistance paradigm could be based only on the fact that effective treatment schedules were simply undeliverable with older RT techniques due to toxicity issues, but the availability of actual techniques may prompt further exploration to offer treatment alternatives to these patients. Ongoing trials on this issue are lacking, but potential areas of research are platinum-refractory disease and consolidation therapy for residual masses after PST.

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Authors and Affiliations

  1. Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy

    Giulio Francolini

  2. Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy

    Luca Eolo Trodella

  3. Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy

    Giulia Marvaso

  4. Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano CRO-IRCCS, Aviano, Pordenone, Italy

    Fabio Matrone

  5. Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, via Don Sempreboni 5, 37034, Verona, Negrar, Italy

    Luca Nicosia

  6. Radioterapia Oncologica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy

    Giorgia Timon

  7. Radiotherapy Unit, San Gaetano Radiotherapy and Nuclear Medicine Center, Palermo, Italy

    Lucia Ognibene

  8. Department of Radiation Oncology, “SS Annunziata” Hospital, “G. D’Annunzio” University, Via dei Vestini, 66100, Chieti, Italy

    Annamaria Vinciguerra

  9. Department of Biomedical Sciences, Humanitas University, Radiotherapy and Radiosurgery Department -Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy

    Ciro Franzese

  10. Radiation Oncology Department, University and Spedali Civili of Brescia, Brescia, Italy

    Paolo Borghetti

  11. Department of Radiation Oncology, School of Medicine and Surgery-University of Milan Bicocca, Milan, Italy

    Stefano Arcangeli

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  1. Giulio Francolini
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Correspondence to Giulio Francolini.

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Francolini, G., Trodella, L.E., Marvaso, G. et al. Radiotherapy role in non-seminomatous germ cell tumors, radiobiological and technical issues of an unexplored scenario. Int J Clin Oncol 26, 1777–1783 (2021). https://doi.org/10.1007/s10147-021-01989-7

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