[Testis germ cell tumours: which chemotherapy, for which patients?]

Abstract

Germ cell tumours of the testis are curable disease. Two different pathological subtypes are observed: seminoma and non-seminoma. Two tumour stages have been defined: the disease limited to the testis and the advanced disease. In the latter group, the prognosis is established by a specific classification based on the level of serum tumour marker and the location of the metastases. The most active first line chemotherapy is a combination of bleomycine, etoposide and cisplatine. Patients with good prognostic factors receive three cycles of this regimen; patients with poor-risk characteristics receive four cycles of the same regimen. The strategy in non-seminoma patients is to give a first-line chemotherapy adapted to the risk factors, then to complete surgical exeresis of all residual disease. Patients with stage I disease may receive two cycles of the same regimen. The strategy for advanced seminoma is to give first-line good-risk chemotherapy followed by a close observation and in several selected cases a surgical removal of all residual disease. Patients with stage I disease may receive one cycle of carboplatin. Salvage chemotherapy is based on the combination of ifosfamide, cisplatine and either vinblastine or paclitaxel.