Management of patients with low-stage nonseminomatous germ cell testicular cancer Journal Article

Authors: Stephenson, A. J.; Sheinfeld, J.
Article Title: Management of patients with low-stage nonseminomatous germ cell testicular cancer
Abstract: Management options for patients with clinical stage (CS) I nonseminomatous germ cell testicular cancer (NSGCT) include surveillance, retroperitoneal lymph node dissection (RPLND), or two cycles of bleomycin-etoposide-cisplatin (BEP×2) chemotherapy. The optimal management of these patients is controversial, as cure rates of 97% or greater are reported with each of these treatment modalities. Patients without evidence of lymphovascular invasion, a predominant component of embryonal carcinoma, or advanced pathologic (p) T stage (pT2 or greater) are at low risk for occult metastases and are optimal candidates for surveillance. Compliance with diagnostic testing and imaging is essential for a successful surveillance strategy to detect and treat metastases at an early stage. For patients who are not candidates for surveillance, RPLND offers several advantages over chemotherapy. RPLND alone is curative in 50% to 80% of CS I patients with pathologic stage (PS) II, and an estimated 75% of CS I patients avoid chemotherapy (as adjuvant therapy or for treatment of relapse). Virtually all patients are cured following two cycles of adjuvant chemotherapy for PS II disease, which is reserved for patients with high-volume (PN2-3) retroperitoneal disease. The poor outcome of patients with late retroperitoneal recurrence from unresected, chemorefractory germ cell testicular cancer indicates that RPLND is a vital component to the long-term cure of patients with NSGCT. Approximately 20% to 30% of patients with PS II disease have retroperitoneal teratoma (which is chemoresistant), and an estimated 5% of PS II patients have chemoresistant viable cancer following BEP×2 as primary therapy. When RPLND is omitted, these patients are at risk for late recurrence with potentially lethal consequences. Patients who relapse after RPLND are "chemotherapy-naïve" and cured in virtually all cases with good-risk chemotherapy regimens. When nerve-sparing techniques are employed to preserve ejaculation, RPLND is also associated with a more favorable long-term toxicity profile compared with chemotherapy. In the absence of conclusive evidence from a randomized trial, we believe RPLND is the treatment of choice for patients with CS I NSGCT who are not candidates for surveillance, as it offers the greatest likelihood of long-term cure with considerably less morbidity than primary chemotherapy. Copyright © 2005 by Current Science Inc.
Keywords: cancer survival; treatment outcome; leukemia; surgical technique; disease course; review; cancer recurrence; cisplatin; cancer combination chemotherapy; pathophysiology; cancer adjuvant therapy; postoperative care; cancer staging; methodology; lymph node metastasis; lymph node dissection; paraaortic lymph node; lymphatic metastasis; neoplasm staging; laparoscopy; lymph node excision; computer assisted tomography; lung toxicity; etoposide; kidney disease; peripheral neuropathy; morbidity; cancer screening; tumor marker; risk factor; cancer mortality; infertility; risk assessment; cause of death; survival time; cardiovascular disease; cardiovascular risk; testicular neoplasms; patient compliance; bleomycin; intermethod comparison; cancer relapse; visceral metastasis; thorax radiography; neoplasms, germ cell and embryonal; metastasis potential; orchiectomy; autopsy; risk reduction; testis cancer; non seminomatous germinoma; raynaud phenomenon; male fertility; ototoxicity; retroperitoneal disease; ejaculation disorder
Journal Title: Current Treatment Options in Oncology
Volume: 6
Issue: 5
ISSN: 1527-2729
Publisher: Springer  
Date Published: 2005-09-01
Start Page: 367
End Page: 377
Language: English
PUBMED: 16107240
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 16" - "Export Date: 24 October 2012" - "CODEN: CTOOB" - "Source: Scopus"