[Stage-specific treatment for testicular germ cell tumours]

Abstract

Testicular germ cell tumours (GCT) represent the most common solid neoplasm of young men aged 20-40 years with an increasing incidence in Western countries during the last 50 years. It is mandatory for all physicians involved in the primary care of testis cancer patients to adhere to the guidelines of stage-specific treatment in order not to impair the high cure rate of about 90% and to prevent long-term toxicities due to inadequate therapy.Risk-adapted therapeutic options in stage I seminoma include active surveillance, retroperitoneal radiation therapy (RT) with 20 Gy or carboplatinum monotherapy depending on the presence of the risk factors tumour size > 4 cm and rete testis invasion. Retroperitoneal RT represents the standard therapeutic approach in stage IIA seminoma, whereas RT and PEB chemotherapy are alternative treatment options in stage IIB tumours. Primary chemotherapy with 3-4 cycles PEB according to the IGCCCG criteria is the treatment of choice in metastatic seminomas >/= stage IIC. In clinical stage I NSGCT active surveillance is the treatment of choice in low-risk patients, and primary chemotherapy with 1-2 cycles PEB is the preferred treatment for high-risk patients.Treatment of metastatic GCT is performed with 3-4 cycles PEB chemotherapy and postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) in cases of residual disease according to the IGCCCG risk classification. PC-RPLND is best performed in experienced centres due to the complex nature of surgery and the necessity for adjunctive surgery in 25% of the patients. PC-RPLND, primary treatment of patients with intermediate and poor prognosis and salvage therapy should be performed in tertiary referral centres only.