Management of stage I testicular germ cell tumours.
Clinical stage I testicular germ cell tumours (TGCT) are highly curable neoplasms. The treatment of stage I testicular cancer is complex and requires a multidisciplinary approach. Standard options after radical orchiectomy for seminoma include active surveillance, radiation therapy or 1-2 cycles of carboplatin, and options for nonseminoma include active surveillance, retroperitoneal lymph node dissection (RPLND) or 1-2 cycles of bleomycin plus etoposide plus cisplatin (BEP). All the options should be discussed with each patient and treatment choices should be made by shared decision making as virtually all patients with clinical stage I TGCT can be cured of their disease. Long-term survival of men with stage I disease is ∼99% and care must be taken to limit the long-term risks of treatment. Orchiectomy is curative in the majority of patients. The management of clinical stage I TGCT remains controversial among experts at high-volume centres throughout the world. The main controversy is whether to overtreat a substantial number of patients with stage I disease to prevent relapse, or to observe and treat only patients who experience disease relapse as adjuvant treatment and surveillance strategy both bring curative outcome. Thus, a summary of the available evidence in stage I disease and recommendations for disease management from a high-volume centre such as Indiana University might be of interest to treating clinicians.
2nd Department of Oncology, Comenius University, Faculty of Medicine &National Cancer Institute, Klenova 1, Bratislava 83310, Slovak Republic.
Michal
M
Chovanec
Division of Hematology/Oncology, Indiana University Simon Cancer Center, 535 Barnhill Drive, Indianapolis, Indiana 46202, USA.
Nasser
N
Hanna
Division of Hematology/Oncology, Indiana University Simon Cancer Center, 535 Barnhill Drive, Indianapolis, Indiana 46202, USA.
K Clint
KC
Cary
Division of Hematology/Oncology, Indiana University Simon Cancer Center, 535 Barnhill Drive, Indianapolis, Indiana 46202, USA.
Lawrence
L
Einhorn
Division of Hematology/Oncology, Indiana University Simon Cancer Center, 535 Barnhill Drive, Indianapolis, Indiana 46202, USA.
Costantine
C
Albany
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001761:Bleomycin; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin; D003131:Combined Modality Therapy; D005047:Etoposide; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology* / Q000628:therapy*; D009919:Orchiectomy; D017410:Practice Guidelines as Topic; D018714:Radiotherapy, Adjuvant; D013736:Testicular Neoplasms / Q000473:pathology* / Q000628:therapy*
D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin