Initial risk-stratified treatment for advanced testicular germ cell tumors
- Timothy D Gilligan, MD
Timothy D Gilligan, MD
- Associate Professor of Medicine
- Cleveland Clinic Lerner College of Medicine
- Vice-Chair for Education
- Cleveland Clinic Taussig Cancer Institute
- Director of Coaching, Center for Excellence in Healthcare Communication
- Cleveland Clinic
- Philip W Kantoff, MD
Philip W Kantoff, MD
- Section Editor — Testicular Cancer
- Chairman of Medicine
- Memorial Sloan Kettering Cancer Center
Testicular cancers are one of the most curable solid neoplasms. In the United States, the five-year survival rate is over 95 percent, and approximately 400 deaths from testicular cancer are seen per year . (See "Clinical manifestations, diagnosis, and staging of testicular germ cell tumors" and "Epidemiology of and risk factors for testicular germ cell tumors".)
Factors that have likely contributed to the declining mortality rate from testicular cancer include the development and use of effective chemotherapy, a trend toward earlier stage disease at presentation, and an increasing proportion of tumors that are pure seminomas .
The risk stratification of advanced testicular germ cell tumors (GCTs) and initial management based on risk will be reviewed here. The clinical manifestations, diagnosis, and staging, an overview of the approach, the surgical treatment, and the approach to early stage testicular GCTs are reviewed separately. In addition, chemotherapy protocols used in the management of GCTs are also covered separately.
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- GENERAL APPROACH TO ADVANCED DISEASE
- DEFINITION OF RISK
- Nonseminomatous germ cell tumors
- - Good risk
- - Intermediate risk
- - Poor risk
- TREATMENT OPTIONS
- Good risk
- - Bleomycin, etoposide, and cisplatin
- - Etoposide and cisplatin
- - Is there a role for carboplatin?
- - Chemotherapy-related toxicity
- Intermediate- and poor-risk advanced disease
- - BEP
- - VIP
- Chemotherapy-related toxicity
- MONITORING RESPONSE TO TREATMENT
- Nonseminomatous germ cell tumors
- Long-term prognosis
- SUMMARY AND RECOMMENDATIONS