Abstract
Testicular cancer represents the most common malignancy in males aged 15–34 years and is considered a model of curable neoplasm. Maintaining success, reducing treatment burden, and focusing on survivorship are then key objectives. Inguinal orchiectomy is the first recommended maneuver that has both diagnostic and therapeutic aims. Most patients are diagnosed with stage I disease (confined to the testicle). Close surveillance and selective, short-course adjuvant chemotherapy are accepted alternatives for these cases. In patients with more advanced disease (stages II and III), 3–4 courses of cisplatin-based chemotherapy (according to IGCCCG risk classification) followed by the judicious surgical removal of residual masses represent the cornerstone of therapy. Poor-risk patients and those failing a first-line therapy should be referred to specialized tertiary centers. Paclitaxel-based conventional chemotherapy and high-dose chemotherapy plus autologous hematopoietic support can cure a proportion of patients with relapsing or refractory disease.
Highlights
To develop updated, accurate clinical guidelines, the Spanish Society of Medical Oncology (SEOM) and the Spanish Germ Cell Cancer Group (SGCCG) invited ten experts based on major scientific contribution in the field of germ-cell testicular cancer (GCTC)
In patients with more advanced disease, 3–4 courses of cisplatin-based chemotherapy followed by the judicious surgical removal of residual masses represent the cornerstone of therapy
Accurate clinical guidelines, the Spanish Society of Medical Oncology (SEOM) and the Spanish Germ Cell Cancer Group (SGCCG) invited ten experts based on major scientific contribution in the field of germ-cell testicular cancer (GCTC)
Summary
Accurate clinical guidelines, the Spanish Society of Medical Oncology (SEOM) and the Spanish Germ Cell Cancer Group (SGCCG) invited ten experts based on major scientific contribution in the field of germ-cell testicular cancer (GCTC). Based on the most recent histological taxonomy of GCTC according to the World Health Organization classification (2016 version), testicular germ cell tumors are divided into two different groups: those derived from GCNIS and those unrelated to GCNIS [5]. Recommendation Even though radiotherapy was the classic treatment for stage II-B patients, three cycles of BEP chemotherapy is today the recommended approach to prevent relapses, especially outside the radiation therapy field [16, 17] (II, B). For stages II-C and III considered as low risk as per the IGCCCG classification, three cycles of BEP chemotherapy are the standard treatment [18] (I, A). For patients with good-risk germ cell tumors, three cycles of BEP are considered standard therapy. 30% of metastatic GCTC will present residual masses (RM) after the first-line chemotherapy and their management is one of the most important keynotes for achieving high curability of these neoplasms [23]
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