Recent advances in the treatment of testicular cancer.
Testicular cancer is remarkable because it is curable by combination cytotoxic chemotherapy even when widely disseminated. Treatment is defined by widely accepted staging and prognostic factors. Three cycles of bleomycin, etoposide and cisplatin has been defined as the current optimum treatment in good prognosis metastatic disease, curing 90-95% of patients. Outcomes are less impressive for patients in intermediate and poor prognostic categories. A number of different approaches, including introduction of new agents and dose intensification, are being investigated to improve outcomes in these patients. Data developed over the last few years have identified increased risks of second malignancy and cardiovascular disease in long-term survivors. This has led to re-evaluation of strategies to manage Stage I patients. In particular, the use of radiotherapy in Stage I seminoma and the need for adjuvant therapy in Stage I nonseminoma are being re-examined. It is anticipated that advances in imaging and prognostic factors will facilitate this process.
Huddart
Robert A
RA
The Royal Marsden NHS Foundation Trust & The Institute of Cancer Research, The Academic Unit of Radiotherapy & Oncology, Downs Road, Sutton, Surrey, SM2 5PT, UK. Robert.Huddart@icr.ac.uk
Birtle
Alison J
AJ
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000139:chemically induced; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000139:chemically induced; D011379:Prognosis; D012307:Risk Factors; D018239:Seminoma / Q000188:drug therapy* / Q000601:surgery; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000601:surgery
D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin