Current treatment of high risk testis cancer

Abstract

The incidence of testicular cancer in Europe is doubling every 20 years. The incidence in Europe is 6.3/100,000/year with the highest rate in North European countries (6.8/100,000/year). Today, cure rates of 95–99% for patients with early stage testicular cancer are achievable, but the prognosis of patients with non-pulmonary visceral disease and/or highly raised tumour markers is generally poor: these patients have a 50% chance of cure. Patients’ prognoses are assessed according to the International Germ Cell Cancer Consensus Conference (IGCCCG) scale, in which patients are assigned to a good (90% seminoma, 56% non seminoma; 90% survival), intermediate (10% seminoma, 28% non seminoma; 80% survival), or poor (16% non seminoma; 60% survival) prognosis group. The assignment of a prognostic group is important to decide the best treatment approach. Serum tumour markers are critical in the assignment of prognosis and management during treatment as well. Serum concentration of alpha fetoprotein (AFP) and/or human chorionic gonadotropin (hCG) are elevated in 80% of patients with advanced non seminoma, and nearly all patients with intermediate or poor-prognosis disease. In seminoma, Laktatdehydrogenase (LDH) and hCG are important markers, but only non-pulmonary visceral metastases separate an intermediate from a good prognosis. This educational will focus on the treatment of patients with advanced disease which includes intermediate and poor prognosis first-line treatment, salvage therapy and the role of high dose chemotherapy (HDCT).