Recommandations en onco-urologie 2016-2018 du CCAFU : Tumeurs germinales testiculaires

Abstract

IntroductionThe purpose of the oncologic comitee of the french association of urology was to establish guidelines proposed by the external genital organ group, for the diagnosis, treatment and follow-up of the germ cell tumours of the testis. Material and MethodsThe multidisciplinary working group studied 2013 guidelines, exhaustively reviewed the literature, and evaluated references and their level of proof in order to attribute grades of recommandation. ResultsThe initial workup of testicular cancer is based on clinical, laboratory (AFP, total hCG, LDH) and imaging assessment (scrotal ultrasound and chest, abdomen and pelvis computed tomography).Inguinal orchiectomy is the first line treatment allowing characterization of the histological type, local staging and identification of risk factors for micrometastases. The management of stage I tumors is based on surveillance or on a risk-adapted approach with explaining to the patient the benefits/disadvantages of active treatment or watchful waiting as a function of the risk of relapse.Treatment options for stage I seminomas comprise: surveillance, chemotherapy (1cycle of carboplatin) or para-aortic radiotherapy.Treatment options for stage I nonseminomatous germ cell tumours comprise: surveillance, chemotherapy (1cycle of BEP) or staging retroperitoneal lymphadenectomy. The management of metastatic tumors essentially comprises chemotherapy with 3, 4 cycles of BEP or dose-dense chemotherapy according to the IGCCCG. Radiotherapy may be indicated in seminomas with lymph node metastasis < 3cm. Review 3 to 4 weeks postchemotherapy is essentially based on tumor marker assays and chest, abdomen and pelvis computed tomography. Surgical retroperitoneal lymph node dissection is indicated for all residual NSGCT masses > 1cm and for persistent residual seminoma masses > 3cm with 18F- FDG PET- CT uptake. ConclusionsGood Germ cell tumors specific survival rates (99% CSI, 85% CSII, III) are based on precise initial staging, adapted and strictly defined treatment and close surveillance.© 2016 Elsevier Masson SAS. All rights reserved.