title: Epidemiology of male seminomatous and nonseminomatous germ cell tumors and response to first-line chemotherapy from a tertiary cancer center in India.
abstract: BACKGROUND
  Unlike the developed countries, there is a lack of good epidemiologic data for testicular germ cell tumors (GCTs) in India with majority presenting in advanced stage. This study aims to elaborate on the epidemiology of testicular GCTs and response to standard first-line chemotherapy (CT).
  
  
  METHODS
  GCTs treated at our center from January 2013 to June 2014 were retrospectively analyzed. Patients underwent orchidectomy either outside or at our hospital. Based on stage and risk group, standard CT (bleomycin, etoposide, and cisplatin/etoposide and cisplatin/carboplatin AUC7) and radiotherapy were given as appropriate. Response was calculated based on the Response Evaluation Criteria in Solid Tumors. Statistical analysis was performed using SPSS 18 software.
  
  
  RESULTS
  Fifty nonseminomatous germ cell tumor (NSGCT) and 36 of SGCT cases were studied. 30%, 46%, and 64% of NSGCT and 11%, 28%, and 22% of SGCT had N2, N3, and M1 diseases, respectively. The mean nodal size was 7 cm (1.5-19) in NSGCT and 5.5 cm (1.3-11) in SGCT. As per the International Germ Cell Cancer Collaborative Group classification, in patients with metastatic disease, 9% of NSGCT were good, 53% were intermediate, and 38% were poor risk whereas 75% of SGCT were good and 25% were intermediate risk. Following CT among NSGCT, 5% and 71% had radiologic complete response (CR) and partial response (PR), respectively. Among SGCT, 46% and 38% had radiologic CR and PR, respectively. 22%, 53%, and 13% of NSGCT and 12%, 24%, and 20% of SGCT developed febrile neutropenia, Grade 3 or 4 hematological and nonhematological toxicities, respectively, after standard chemotherapy.
  
  
  CONCLUSIONS
  GCTs in India present with high nodal and high-risk diseases wherein the standard first-line CT may not be adequate as curative therapy; however, significant chemotoxicity is also a hindrance.
authors.affiliation: Tata Memorial Centre, Mumbai, Maharashtra, India.
authors.forename: A
authors.initials: A
authors.lastname: Joshi
authors.affiliation: Tata Memorial Centre, Mumbai, Maharashtra, India.
authors.forename: S
authors.initials: S
authors.lastname: Zanwar
authors.affiliation: Department of Medical Oncology, Father Muller Medical College Hospital, Mangalore, Karnataka, India.
authors.forename: N
authors.initials: N
authors.lastname: Shetty
authors.affiliation: Tata Memorial Centre, Mumbai, Maharashtra, India.
authors.forename: V
authors.initials: V
authors.lastname: Patil
authors.affiliation: Tata Memorial Centre, Mumbai, Maharashtra, India.
authors.forename: V
authors.initials: V
authors.lastname: Noronha
authors.affiliation: Tata Memorial Centre, Mumbai, Maharashtra, India.
authors.forename: G
authors.initials: G
authors.lastname: Bakshi
authors.affiliation: Tata Memorial Centre, Mumbai, Maharashtra, India.
authors.forename: G
authors.initials: G
authors.lastname: Prakash
authors.affiliation: Tata Memorial Centre, Mumbai, Maharashtra, India.
authors.forename: S
authors.initials: S
authors.lastname: Menon
authors.affiliation: Tata Memorial Centre, Mumbai, Maharashtra, India.
authors.forename: K
authors.initials: K
authors.lastname: Prabhash
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D055815:Young Adult