title: The clinical features and management of testicular germ cell tumours in patients aged 60 years and older.
abstract: What's known on the subject ? and What does the study add? The treatment of younger men with testicular germ cell cancers is well documented with established intensive chemotherapy regimens for those with advanced disease. Although the majority of patients present in the third or fourth decade, men also present in later life. These patients are typically excluded from clinical trials and there are no contemporary published series describing their management. This series describes the management of older patients with testicular germ cell tumours at both early and advanced stages of disease. Patients with stage I seminoma can be safely managed with all recognised treatment strategies and state I non-seminomas were managed with surveillance. Cure can still be achieved in older patients with advance germ cell tumours however chemotherapy regimens developed in younger patients must be tailored to the presence of co-morbidity.
  
  
  OBJECTIVE
  • To review the practice of a large referral centre for the management of older patients with testicular germ cell cancer (GCC). • There are few published data available on the management of testicular GCC in elderly patients, who often have medical comorbidities and have been excluded from clinical trials.
  
  
  METHODS
  • We reviewed our prospectively collected database for patients presenting with GCC who were aged ≥60 years. • Details of presentation, management and outcome were recorded.
  
  
  RESULTS
  • In total, 60 patients aged ≥60 years were identified from 1461 patients treated with GCC from 1979-2005, representing 4% of the total population. • Median age was 67 years, 44 had seminoma (73%) and 16 had non-seminoma histology (27%). • Stage I seminoma patients were managed with surveillance, adjuvant radiotherapy and adjuvant carboplatin. All stage I non-seminomas underwent surveillance. • In total, 15 patients received systemic chemotherapy for metastatic disease with modified bleomycin, etoposide and cisplatin; etoposide and cisplatin; carboplatin-based regimens; or other combinations. Toxicity was manageable, with no toxic deaths. • In total, four patients (6.7%) died of GCC.
  
  
  CONCLUSIONS
  • In elderly patients, GCC should be managed with curative intent. • Conventional therapies are tolerable for most men with stage I seminoma. In metastatic disease, comorbidity may necessitate treatment modifications. • Most patients are cured with manageable toxicity.
authors.affiliation: Department of Medical Oncology, Southampton University Hospitals NHS Trust, UK. m.wheater@soton.ac.uk
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Wheater
authors.forename: James
authors.initials: J
authors.lastname: Manners
authors.forename: Luke
authors.initials: L
authors.lastname: Nolan
authors.forename: Peter D
authors.initials: PD
authors.lastname: Simmonds
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Hayes
authors.forename: Graham M
authors.initials: GM
authors.lastname: Mead
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016208:Databases, Factual; D006801:Humans; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D018239:Seminoma / Q000473:pathology / Q000556:secondary / Q000628:therapy; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome