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Treatment-related toxicity in men with testicular germ cell tumors

Authors
M Dror Michaelson, MD, PhD
William K Oh, MD
Section Editor
Philip W Kantoff, MD
Deputy Editor
Michael E Ross, MD

INTRODUCTION

Testicular cancers, 95 percent of which are germ cell tumors, are among the most curable solid neoplasms because of remarkable treatment advances beginning in the early 1970s. Prior to that time, testicular cancer accounted for 11 percent of all cancer deaths in men between the ages of 25 and 34, and the five-year survival rate was 64 percent [1]. There are less than 400 deaths from testicular cancer annually in the United States, and the five-year survival rate is over 95 percent [2,3].

Testicular germ cell tumors (GCTs) are more sensitive to systemic chemotherapy than any other adult solid tumor. Conventional cisplatin-based regimens can cure up to 80 percent of patients with disseminated GCTs, including those with widespread visceral metastases [4]. An additional group of patients who relapse or have refractory disease can be cured by high-dose chemotherapy.

As a result of these therapeutic successes, the majority of men with testicular GCTs are long-term survivors, and minimizing treatment-related toxicity from conventional and high-dose chemotherapy has become a prime concern.

The adverse effects of conventional doses of commonly used chemotherapeutic agents in testicular GCTs are discussed in this topic. The management of long-term survivors and the late effects of radiation therapy (RT) are discussed separately, as is the general approach to treatment. (See "Approach to the care of long-term testicular cancer survivors" and "Overview of the treatment of testicular germ cell tumors".)

HEMATOLOGIC

For men with good-risk testicular germ cell tumors (GCTs), standard dose chemotherapy (three cycles of bleomycin, etoposide, and cisplatin [BEP (table 1)], or four courses of etoposide and cisplatin [EP]) is generally well tolerated. (See "Initial risk-stratified treatment for advanced testicular germ cell tumors", section on 'Good-risk'.)

                               

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Literature review current through: Nov 2016. | This topic last updated: Mon Nov 28 00:00:00 GMT+00:00 2016.
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