title: Medical treatment of advanced testicular cancer.
abstract: BACKGROUND
  The medical treatment of advanced testicular germ cell tumors has changed over the past 30 years, with long-term survival now achieved in the majority of patients. Clinicians need to be familiar with the available treatment regimens for testicular cancer and their associated toxic effects.
  
  
  OBJECTIVE
  To review the treatments used for advanced testicular germ cell tumors and their associated short-term and long-term complications.
  
  
  METHODS
  A search was performed of all English-language literature (1966 to October 2007) within the MEDLINE database using the terms neoplasms, germ cell, or embryonal or testicular neoplasms restricted to humans, drug therapy, complications, and mortality. The Cochrane Register of Controlled Trials Databases (through October 2007) was also searched using the terms testicular cancer or germ cell tumors. Bibliographies were reviewed to extract other relevant articles. One hundred eighty-six articles were selected based on pertinence to advanced testicular cancer treatment, associated complications, and late relapses with an emphasis on randomized controlled trials.
  
  
  RESULTS
  The treatment of advanced testicular germ cell tumors with cisplatin combination chemotherapy is based on risk stratification (good, intermediate, or poor prognosis) according to pretreatment clinical features of prognostic value. Clinical trials have demonstrated that approximately 90% of patients classified as having a good prognosis achieve a durable complete remission to either 4 cycles of etoposide and cisplatin or 3 cycles of cisplatin, etoposide, and bleomycin. Complete responses are achieved less frequently for patients with intermediate- and poor-risk germ cell tumors, in whom 4 cycles of bleomycin, etoposide, and cisplatin remains the standard of care. Second- and third-line programs, including high-dose chemotherapy, also have curative potential. Chronic toxicities associated with therapy include cardiovascular disease, infertility, and secondary malignancies. Late relapses may also occur.
  
  
  CONCLUSIONS
  Clinical trials have led to evidence-based treatment recommendations for advanced testicular cancer based on risk stratification. Clinicians should be familiar with the potential complications of these therapies.
authors.affiliation: Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
authors.forename: Darren R
authors.initials: DR
authors.lastname: Feldman
authors.forename: George J
authors.initials: GJ
authors.lastname: Bosl
authors.forename: Joel
authors.initials: J
authors.lastname: Sheinfeld
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Motzer
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D003131:Combined Modality Therapy; D005298:Fertility; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000556:secondary / Q000628:therapy*; D016609:Neoplasms, Second Primary; D009919:Orchiectomy / Q000009:adverse effects; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects; D018570:Risk Assessment; D016879:Salvage Therapy; D017741:Survivors; D013736:Testicular Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents