title: Testicular germ cell neoplasms.
abstract: Rapid progress in the management and treatment of testicular germ cell neoplasms has been made during the last 20 years. The development of sensitive radioimmunoassays for the serum tumor markers alpha-fetoprotein and the beta subunit of human chorionic gonadotropin has greatly aided in the diagnosis, staging, and treatment of nonseminomatous neoplasms. The development of effective combination chemotherapy for nonseminomatous germ cell tumors represents the major advance, and has changed a disease that formerly had a 75 percent two-year mortality to one with a 75 percent cure rate. Cis-platinum, vinblastine, and bleomycin have formed the basis of the most effective regimens. All patients should be treated with curative intent, preferably at an academic center by experienced medical oncologists. Toxicity, particularly myelosuppression, with effective regimens has been significant, but is manageable in most cases. If feasible, surgical removal of residual disease should be considered in patients failing to achieve complete remission with induction chemotherapy. Prognosis is poor for patients with remaining disease after chemotherapy and surgery, but some have been saved with VP-16-containing regimens. Most seminomas are curable with radiotherapy alone, but patients presenting with advanced disease (stages III and IV) should be treated initially with chemotherapy.
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001761:Bleomycin / Q000627:therapeutic use; D002369:Castration; D002822:Choriocarcinoma / Q000473:pathology; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004407:Dysgerminoma / Q000473:pathology; D006801:Humans; D008297:Male; D008649:Mesonephroma / Q000473:pathology; D009362:Neoplasm Metastasis; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D013724:Teratoma / Q000473:pathology; D013736:Testicular Neoplasms / Q000473:pathology / Q000628:therapy; D014747:Vinblastine / Q000627:therapeutic use
chemical_list: D001761:Bleomycin; D014747:Vinblastine; D002945:Cisplatin