Testicular Cancer Clinical Practice Guidelines in Oncology
NCCN Categories of Evidence and Consensus
Category 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus.
Category 2A: The recommendation is based on lower-level evidence and there is uniform NCCN consensus.
Category 2B: The recommendation is based on lower-level evidence and there is nonuniform NCCN consensus (but no major disagreement).
Category 3: The recommendation is based on any level of evidence but reflects major disagreement.
All recommendations are category 2A unless otherwise noted.
Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.
Overview
An estimated 8090 new cases of testicular cancer will be diagnosed in the United States in 2008.1 Germ cell tumors (GCTs) comprise 95% of malignant tumors arising in the testes. These tumors also occur occasionally in extragonadal primary sites, but they are still managed the same as testicular GCTs. Although GCTs are relatively uncommon tumors that comprise only 2% of all human malignancies, they constitute the most common solid tumor in men between the ages of 15 and 34 years. In addition, the worldwide incidence of these tumors has more than doubled in the past 40 years.
Several risk factors for GCT development have been identified, including prior history, positive family history, cryptorchidism, testicular dysgenesis, and Klinefelter's syndrome. GCTs are classified as seminoma or nonseminoma. Nonseminomatous tumors often include multiple cell types, including embryonal cell...
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Robert J. Motzer, Neeraj Agarwal, Clair Beard, Graeme B. Bolger, Barry Boston, Michael A. Carducci, Toni K. Choueiri, Robert A. Figlin, Mayer Fishman, Steven L. Hancock, Gary R. Hudes, Eric Jonasch, Anne Kessinger, Timothy M. Kuzel, Paul H. Lange, Ellis G. Levine, Kim A. Margolin, M. Dror Michaelson, Thomas Olencki, Roberto Pili, Bruce G. Redman, Cary N. Robertson, Lawrence H. Schwartz, Joel Sheinfeld and Jue Wang
Robert J. Motzer, Neeraj Agarwal, Clair Beard, Sam Bhayani, Graeme B. Bolger, Mark K. Buyyounouski, Michael A. Carducci, Sam S. Chang, Toni K. Choueiri, Shilpa Gupta, Steven L. Hancock, Gary R. Hudes, Eric Jonasch, Timothy M. Kuzel, Clayton Lau, Ellis G. Levine, Daniel W. Lin, Kim A. Margolin, M. Dror Michaelson, Thomas Olencki, Roberto Pili, Thomas W. Ratliff, Bruce G. Redman, Cary N. Robertson, Charles J. Ryan, Joel Sheinfeld, Jue Wang and Richard B. Wilder
trials is especially encouraged. and Klinefelter syndrome. GCTs are classified as seminoma or nonseminoma. Nonseminomatous tumors often include multiple cell types, including embryonal cell carcinoma, choriocarcinoma, yolk sac tumor, and teratoma
Robert J. Motzer, Eric Jonasch, Neeraj Agarwal, Clair Beard, Sam Bhayani, Graeme B. Bolger, Sam S. Chang, Toni K. Choueiri, Brian A. Costello, Ithaar H. Derweesh, Shilpa Gupta, Steven L. Hancock, Jenny J. Kim, Timothy M. Kuzel, Elaine T. Lam, Clayton Lau, Ellis G. Levine, Daniel W. Lin, M. Dror Michaelson, Thomas Olencki, Roberto Pili, Elizabeth R. Plimack, Edward N. Rampersaud, Bruce G. Redman, Charles J. Ryan, Joel Sheinfeld, Brian Shuch, Kanishka Sircar, Brad Somer, Richard B. Wilder, Mary Dwyer and Rashmi Kumar
– 9 GCTs are classified as seminoma or nonseminoma. Nonseminomatous tumors often include multiple cell types, including embryonal cell carcinoma, choriocarcinoma, yolk sac tumor, and teratoma. Teratomas are considered to be either mature or immature
Timothy Gilligan, Daniel W. Lin, Rahul Aggarwal, David Chism, Nicholas Cost, Ithaar H. Derweesh, Hamid Emamekhoo, Darren R. Feldman, Daniel M. Geynisman, Steven L. Hancock, Chad LaGrange, Ellis G. Levine, Thomas Longo, Will Lowrance, Bradley McGregor, Paul Monk, Joel Picus, Phillip Pierorazio, Soroush Rais-Bahrami, Philip Saylor, Kanishka Sircar, David C. Smith, Katherine Tzou, Daniel Vaena, David Vaughn, Kosj Yamoah, Jonathan Yamzon, Alyse Johnson-Chilla, Jennifer Keller and Lenora A. Pluchino
2 main histologic subtypes: seminoma and nonseminoma. 2 , 11 , 12 Nonseminomas are less common but are more aggressive and often include multiple cell types. When both seminoma and elements of nonseminoma are present, management follows that of a
Chunkit Fung, Paul C. Dinh Jr, Sophie D. Fossa and Lois B. Travis
Approximately 70% of patients with stage I nonseminoma and 80% to 85% with stage I seminoma are cured with orchiectomy alone and 97% to 99% of those who experience relapse are ultimately cured with chemotherapy; thus, surveillance has emerged as an attractive
Chunkit Fung, Sophie D. Fossa, Clair J. Beard and Lois B. Travis
Cisplatin-based chemotherapy 22 and retroperitoneal lymph node dissection (RPLND) 23 – 25 are the cornerstones of nonseminoma management. Radiation treatment is generally reserved for patients with symptomatic metastases that are resistant to chemotherapy
Clair J. Beard, Shilpa Gupta, Robert J. Motzer, Elizabeth K. O'Donnell, Elizabeth R. Plimack, Kim A. Margolin, Charles J. Ryan, Joel Sheinfeld and Darren R. Feldman
– 365 . 4. Daugaard G Gundgaard MG Mortensen MS . Surveillance for stage I nonseminoma testicular cancer: outcomes and long-term follow-up in a population-based cohort . J Clin Oncol 2014 ; 32 : 3817 – 3823 . 5. Kollmannsberger
Darren R. Feldman, Wendy L. Schaffer and Richard M. Steingart
of Coronary Artery Disease in Chemotherapy-Treated Patients in Select Studies Since 2000 Regarding specific causal agents, bleomycin has the strongest association with RP. In a study of 395 patients with good-risk nonseminomas randomized to
Linda A. Jacobs and David J. Vaughn
Tumor Environmental and Endocrine Determinants study between 2002 and 2005. 2 , 4 The study subjects were 46 years of age and younger and had at least one serum sample stored, and their diagnoses were limited to classic seminoma or nonseminoma
Mohammad Abu Zaid, Wambui G. Gathirua-Mwangi, Chunkit Fung, Patrick O. Monahan, Omar El-Charif, Annalynn M. Williams, Darren R. Feldman, Robert J. Hamilton, David J. Vaughn, Clair J. Beard, Ryan Cook, Sandra K. Althouse, Shirin Ardeshir-Rouhani-Fard, Paul C. Dinh Jr, Howard D. Sesso, Lawrence H. Einhorn, Sophie D. Fossa, Lois B. Travis and for the Platinum Study Group
recommendations . J Natl Cancer Inst 2010 ; 102 : 1114 – 1130 . 8. Fung C Fossa SD Milano MT . Cardiovascular disease mortality after chemotherapy or surgery for testicular nonseminoma: a population-based study . J Clin Oncol 2015 ; 33 : 3105
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