Anticancer Res, 2010.
15. Testicular cancer (TC) represents 5% … These tumours seem to be uniformly benign [In the case of a diffuse arrangement of the different components, there are some doubts about the neoplastic nature of the germinal cells and some authors consider these to be entrapped rather than neoplastic [These tumours resemble epithelial tumours of the ovary. Timely diagnosis of testicular cancer. 44: 1389.Eggener, S.E., et al.
Despite the limitations of this study, this represents the strongest evidence on this issue and supports primary RPLND in clinical stage I patients diagnosed with TSTM in the testis [Inform patients with stage 1 non-seminomatous germ cell tumour (NSGCT) about all management options after orchiectomy (surveillance, adjuvant chemotherapy, and retroperitoneal lymph node dissection [RPLND]) including treatment-specific recurrence rates as well as acute and long-term side effects.In patients with stage 1 NSGCT, offer surveillance or risk-adapted treatment based on If patients are not willing to undergo or comply with surveillance, offer one course of cisplatin, etoposide, bleomycin as an adjuvant treatment alternative since it has proven to be superior to RPLND in terms of recurrence rates.Offer surveillance if the patient is willing and able to comply.In low-risk patients not willing (or unsuitable) to undergo surveillance, offer adjuvant chemotherapy with one course of cisplatin, etoposide, bleomycin (BEP).Offer primary chemotherapy with one course of BEP, or surveillance and discuss the advantages and disadvantages.Offer surveillance to patients not willing to undergo adjuvant chemotherapy.Offer nerve-sparing retroperitoneal lymph node dissection (RPLND) to highly selected patients only; those with contraindication to adjuvant chemotherapy and unwilling to accept surveillance.Primary RPLND should be advised in men with teratoma with somatic-type malignancy.Figure 1: Risk-adapted treatment in patients with clinical stage I non-seminoma NSGCT BEP = cisplatin, etoposide, bleomycin; CS = clinical stage; IGCCCG = International Germ Cell CancerCollaborative Group; NS = nerve-sparing; RLNPD = retroperitoneal lymph node dissection; VIP = etoposide, cisplatin, ifosfamide.The first-line treatment of metastatic GCTs depends on:In relapsed patients, a prognostic score has been developed including response to first-line therapy which can be used to estimate patient outcome following salvage chemotherapy [Serum tumour markers should be followed closely until levels fall into the reference ranges based on the expected half-lives for AFP and hCG. Am J Surg Pathol, 2014.
Screening for testicular cancer: U.S. Preventive Services Task Force reaffirmation recommendation statement. Subnormal testosterone levels have been reported in TCSs treated with chemotherapy, when compared to those treated with surgery only or the general population [Hypogonadism increases the risk of insulin resistance and hence the risk of metabolic syndrome, which, in turn, might lead to CVD in the long term [Erectile dysfunction (OR 4.2) has been significantly associated with chemotherapy in a recent multicentre study [Of 481 North American TCSs treated with modern cisplatin-based chemotherapy, 38% were hypogonadal (defined as on testosterone substitution or serum testosterone level ≤ 3.0 ng/mL) [Chronic fatigue (CF) is described as a subjective feeling of emotional, physical and/or cognitive tiredness that is not relieved by rest, and persists for more than six months. EAU Guidelines on Testicular Cancer: 2011 Update . EAU guidelines on testicular cancer. doi: 10.1093/jscr/rjaa122.
Randomized trial of bleomycin, etoposide, and cisplatin compared with bleomycin, etoposide, and carboplatin in good-prognosis metastatic nonseminomatous germ cell cancer: a Multiinstitutional Medical Research Council/European Organization for Research and Treatment of Cancer Trial. greatest dimension; or more than 5 nodes positive, none more than 5 cm; or greatest dimension; or more Adjuvant radiotherapy to a para-aortic (PA) field or to a PA and ipsilateral field (PA and ipsilateral iliac nodes), with a total dose of 20-24 Gy, reduced the relapse rate to 1-3% [Overall, when one or both risk factors were present, 15.5% of the patients under surveillance relapsed whereas 9.3% of those receiving adjuvant carboplatin relapsed. Survival after surgery and first salvage chemotherapy improved by 70% at ten years, following taxane-containing regimens [Desperation surgery refers to resection of non-responsive or progressive (e.g. Members of this panel have been selected, based on their expertise, to represent the professionals treating patients suspected of harbouring testis cancer. There is limited experience with incompletely differentiated sex cord/gonadal stromal tumours and no reported cases of metastasis.
2018 Jan;73(1):111-122. doi: 10.1016/j.eururo.2017.07.036. 179: 163.International Prognostic Factors Study Group.
Long-term effects of chemotherapy in patients with testicular cancer. 2015. Copyright © 2011 European Association of Urology. A RPLND may be an alternative option. With this group the available data support BEP x 4 as standard treatment [Patients with intermediate prognosis treated in recent years (after 1997) are more likely to have a five year survival of near 90% [For patients with a ‘poor-prognosis’ non-seminoma as defined by the IGCCCG, standard treatment consists of BEP x 4 with five-year PFS of 45%-50%.