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Management of stage I testicular germ cell tumours

Nature Reviews Urology volume 13, pages 663673 (2016) | Download Citation

Abstract

Clinical stage I testicular germ cell tumours (TGCT) are highly curable neoplasms. The treatment of stage I testicular cancer is complex and requires a multidisciplinary approach. Standard options after radical orchiectomy for seminoma include active surveillance, radiation therapy or 1–2 cycles of carboplatin, and options for nonseminoma include active surveillance, retroperitoneal lymph node dissection (RPLND) or 1–2 cycles of bleomycin plus etoposide plus cisplatin (BEP). All the options should be discussed with each patient and treatment choices should be made by shared decision making as virtually all patients with clinical stage I TGCT can be cured of their disease. Long-term survival of men with stage I disease is 99% and care must be taken to limit the long-term risks of treatment. Orchiectomy is curative in the majority of patients. The management of clinical stage I TGCT remains controversial among experts at high-volume centres throughout the world. The main controversy is whether to overtreat a substantial number of patients with stage I disease to prevent relapse, or to observe and treat only patients who experience disease relapse as adjuvant treatment and surveillance strategy both bring curative outcome. Thus, a summary of the available evidence in stage I disease and recommendations for disease management from a high-volume centre such as Indiana University might be of interest to treating clinicians.

Key points

  • The treatment of stage I testicular cancer is complex and requires a multidisciplinary approach

  • Three acceptable options recommended by guidelines exist for the management of clinical stage I seminoma — active surveillance, adjuvant radiotherapy or adjuvant chemotherapy

  • Options for clinical stage I nonseminoma incude active surveillance, adjuvant chemotherapy and retroperitoneal lymph node dissection

  • The extremely high cure rate of testicular germ cell tumours means that the long-term sequelae of therapy must be considered in this population of men

  • Progression-free but not overall survival improves with radiotherapy or carboplatin chemotherapy in clinical stage I seminoma, and one cycle of bleomycin plus etoposide plus cisplatin or retroperitoneal lymph node dissection in nonseminoma

  • At Indiana University, active surveillance is the preferred modality, based on the effort to minimize overtreatment and late treatment sequelae without compromising overall survival

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Acknowledgements

M.C. is supported by UICC ICRETT fellowship ICR 2014 347446 and the Slovak Research and Development Agency under contract No. APVV-0016-11 and APVV-15-0086. C.A. is funded by an Alliance Scholar Grant from Alliance for Clinical Trials in Oncology Foundation.

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Affiliations

  1. 2nd Department of Oncology, Comenius University, Faculty of Medicine & National Cancer Institute, Klenova 1, Bratislava 83310, Slovak Republic.

    • Michal Chovanec
  2. Division of Hematology/Oncology, Indiana University Simon Cancer Center, 535 Barnhill Drive, Indianapolis, Indiana 46202, USA.

    • Nasser Hanna
    • , K. Clint Cary
    • , Lawrence Einhorn
    •  & Costantine Albany

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All authors researched data for, contributed to discussion of content and reviewed and edited the manuscript before submission. M.C. and C.A. wrote the article.

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https://doi.org/10.1038/nrurol.2016.164

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