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

  • Francolini, Giulio1
  • Trodella, Luca Eolo2
  • Marvaso, Giulia3
  • Matrone, Fabio4
  • Nicosia, Luca5
  • Timon, Giorgia6
  • Ognibene, Lucia7
  • Vinciguerra, Annamaria8
  • Franzese, Ciro9
  • Borghetti, Paolo10
  • Arcangeli, Stefano11
  • 1 Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy. [email protected] , (Italy)
  • 2 Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy. , (Italy)
  • 3 Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. , (Italy)
  • 4 Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano CRO-IRCCS, Aviano, Pordenone, Italy. , (Italy)
  • 5 Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, via Don Sempreboni 5, 37034, Verona, Negrar, Italy. , (Italy)
  • 6 Radioterapia Oncologica, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy. , (Italy)
  • 7 Radiotherapy Unit, San Gaetano Radiotherapy and Nuclear Medicine Center, Palermo, Italy. , (Italy)
  • 8 Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via dei Vestini, 66100, Chieti, Italy. , (Italy)
  • 9 Department of Biomedical Sciences, Humanitas University, Radiotherapy and Radiosurgery Department -Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy. , (Italy)
  • 10 Radiation Oncology Department, University and Spedali Civili of Brescia, Brescia, Italy. , (Italy)
  • 11 Department of Radiation Oncology, School of Medicine and Surgery-University of Milan Bicocca, Milan, Italy. , (Italy)
Published Article
International journal of clinical oncology
Publication Date
Oct 01, 2021
DOI: 10.1007/s10147-021-01989-7
PMID: 34273014


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 However, case series exploring the use of radiation treatment in this setting are often outdated, and prospective ongoing studies testing new radiotherapeutic approaches in NSGCT are lacking.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. © 2021. Japan Society of Clinical Oncology.

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