Testicular Cancer Clinical Practice Guidelines in OncologyNCCN Categories of Evidence and ConsensusCategory 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.OverviewAn 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...

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1

    Jemal A, Siegel R, Ward E. Cancer statistics, 2008. CA Cancer J Clin 2008;58:7196.

  • 2

    Jones RH, Vasey PA. Part I: testicular cancer—management of early disease. Lancet Oncol 2003;4:730737.

  • 3

    Fossa SD, Chen J, Schonfeld SJ. Risk of contralateral testicular cancer: a population based study of 29,515 US men. J Natl Cancer Inst 2005;97:10561066.

    • Search Google Scholar
    • Export Citation
  • 4

    Jones WG, Fossa SD, Mead GM. Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I testicular seminoma: a report on Medical Research Council Trial TE18, European Organisation for the Research and Treatment of Cancer Trial 30942 (ISRCTN18525328). J Clin Oncol 2005;23:12001208.

    • Search Google Scholar
    • Export Citation
  • 5

    Oliver RT, Mason MD, Mead GM. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomized trial. Lancet 2005;366:293300.

    • Search Google Scholar
    • Export Citation
  • 6

    Oliver RT, Mead GM & Fogarty PJ Radiotherapy versus carboplatin for stage I seminoma: updated analysis of the MRC/EORTC randomized trial (ISRCTN27163214) [abstract]. J Clin Oncol 2008;26:(Suppl 1):Abstract 1.

    • Search Google Scholar
    • Export Citation
  • 7

    Alomary I, Samant R, Gallant V. Treatment of stage I seminoma: a 15 year review. Urol Oncol 2006;24:180183.

  • 8

    Gospodarowicz M, Sturgeon JF, Jewitt MA. Early stage and advanced seminoma: role of radiation therapy, surgery, and chemotherapy. Semin Oncol 1998;25:160173.

    • Search Google Scholar
    • Export Citation
  • 9

    de Wit R, Roberts JT, Wilkinson PM. Equivalence of three or four cycles of bleomycin, etoposide, and cisplatin chemotherapy and of a 3- or 5-day schedule in good-prognosis germ cell cancer: a randomized study of the European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group and the Medical Research Council. J Clin Oncol 2001;19:16291640.

    • Search Google Scholar
    • Export Citation
  • 10

    Loehrer PJ Sr, Johnson D, Elson P. Importance of bleomycin in favorable-prognosis disseminated germ cell tumors: an Eastern Cooperative Oncology Group trial. J Clin Oncol 1995;13:470476.

    • Search Google Scholar
    • Export Citation
  • 11

    Bajorin DF, Sarosdy MF, Pfister DG. Randomized trial of etoposide and cisplatin versus etoposide and carboplatin in patients with good-risk germ cell tumors: a multiinstitutional study. J Clin Oncol 1993;11:598606.

    • Search Google Scholar
    • Export Citation
  • 12

    Kondagunta GV, Bacik J, Bajorin D. Etoposide and cisplatin chemotherapy for metastatic good-risk germ cell tumors. J Clin Oncol 2005;23:92909294.

    • Search Google Scholar
    • Export Citation
  • 13

    Becherer A, De Santis M, Karanikas G. FDG PET is superior to CT in the prediction of viable tumour in post-chemotherapy seminoma residuals. Eur J Radiol 2005;54:284288.

    • Search Google Scholar
    • Export Citation
  • 14

    Warde P, Gospodarowicz MK, Panzarella T. Stage I testicular seminoma: results of adjuvant irradiation and surveillance. J Clin Oncol 1995;13:22552262.

    • Search Google Scholar
    • Export Citation
  • 15

    Puc HS, Heelan R, Mazumdar M. Management of residual mass in advanced seminoma: results and recommendations from the Memorial Sloan-Kettering Cancer Center. J Clin Oncol 1998;14:454460.

    • Search Google Scholar
    • Export Citation
  • 16

    Mencel PJ, Motzer RJ, Mazumdar M. Advanced seminoma: treatment results, survival, and prognostic factors in 142 patients. J Clin Oncol 1994;12:120126.

    • Search Google Scholar
    • Export Citation
  • 17

    Sheinfeld J, Herr H. Role of surgery in management of germ-cell tumors. Semin Oncol 1998;25:203209.

  • 18

    Carver BS, Sheinfeld J. The current status of laparoscopic retroperitoneal lymph node dissection for non-seminomatous germ-cell tumors. Nat Clin Pract Urol 2005;2:330335.

    • Search Google Scholar
    • Export Citation
  • 19

    Davis BE, Herr HW, Fair WR. The management of patients with nonseminomatous germ-cell tumors of the testis with serologic disease only after orchiectomy. J Urol 1994;152:111114.

    • Search Google Scholar
    • Export Citation
  • 20

    Culine S, Theodore C, Terrier-Lacombe MJ, Droz JP. Primary chemotherapy in patients with nonseminomatous germ cell tumors of the testis and biological disease only after orchiectomy. J Urol 1996;155:12961298.

    • Search Google Scholar
    • Export Citation
  • 21

    Foster R, Bihrle R. Current status of retroperitoneal lymph node dissection and testicular cancer: when to operate. Cancer Control 2002;9:277283.

    • Search Google Scholar
    • Export Citation
  • 22

    Motzer RJ, Sheinfeld J, Mazumdar M. Etoposide and cisplatin adjuvant therapy for patients with pathologic stage II germ-cell tumors. Classic Papers and Current Comments: Highlights of Genitourinary Cancer Research 1998b;2:455459.

    • Search Google Scholar
    • Export Citation
  • 23

    International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group. J Clin Oncol 1997;15:594603.

    • Search Google Scholar
    • Export Citation
  • 24

    Williams SD, Birch R, Einhorn LH. Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med 1987;316:14351440.

    • Search Google Scholar
    • Export Citation
  • 25

    Bosl GJ, Geller NL, Bajorin D. A randomized trial of etoposide + cisplatin vs vinblastine + bleomycin + cisplatin + cyclophosphamide + dactinomycin in patients with good-prognosis germ-cell tumors. J Clin Oncol 1988;6:12311238.

    • Search Google Scholar
    • Export Citation
  • 26

    Einhorn LH, Williams SD, Loehrer PJ. Evaluation of optimal duration of chemotherapy in favorable-prognosis disseminated germ-cell tumors: a Southeastern Cancer Study Group protocol. J Clin Oncol 1989;7:387391.

    • Search Google Scholar
    • Export Citation
  • 27

    Jones RH, Vasey PA. Part II: testicular cancer—management of advanced disease. Lancet Oncol 2003;4:738747.

  • 28

    Toner GC, Motzer RJ. Poor prognosis germ-cell tumors: current status and future directions. Semin Oncol 1998;25:194202.

  • 29

    Loehrer PJ Sr, Lauer R, Roth BJ. Salvage therapy in recurrent germ cell cancer: ifosfamide and cisplatin plus either vinblastine or etoposide. Ann Intern Med 1988;109:540546.

    • Search Google Scholar
    • Export Citation
  • 30

    Motzer RJ, Geller NL, Tan CC. Salvage chemotherapy for patients with germ-cell tumors. The Memorial Sloan-Kettering Cancer Center experience (1979–1989). Cancer 1991;67:13051310.

    • Search Google Scholar
    • Export Citation
  • 31

    McCaffrey JA, Mazumdar M, Bajorin DF. Ifosfamide + cisplatin regimens as first-line salvage therapy in germ-cell tumors: response and survival (abstract). Proc Am Soc Clin Oncol 1996;14:Abstract 250.

    • Search Google Scholar
    • Export Citation
  • 32

    Loehrer PJ, Gonin R, Nichols CR. Vinblastine plus ifosfamide plus cisplatin as initial salvage therapy in recurrent germ-cell tumor. J Clin Oncol 1998;16:25002504.

    • Search Google Scholar
    • Export Citation
  • 33

    Motzer RJ, Bosl GJ. High-dose chemotherapy for resistant germ-cell tumors: recent advances and future directions. J Natl Cancer Inst 1992;84:17031709.

    • Search Google Scholar
    • Export Citation
  • 34

    Beyer J, Kramer A, Mandanas R. High-dose chemotherapy as salvage treatment in germ cell tumors: a multivariate analysis of prognostic variables. J Clin Oncol 1996;14:26382645.

    • Search Google Scholar
    • Export Citation
  • 35

    Wood DP, Herr H, Motzer RJ. Surgical resection of solitary metastases after chemotherapy in patients with non-seminomatous germ-cell tumors and elevated serum tumor markers. Cancer 1992;70:23542357.

    • Search Google Scholar
    • Export Citation
  • 36

    Pectasides D, Pectasides M, Farmakis D. Gemcitabine and oxaliplatin (GEMOX) in patients with cisplatin-refractory germ cell tumors: a phase II study. Ann Oncol 2004;15:493497.

    • Search Google Scholar
    • Export Citation
  • 37

    Kollmannsberger C, Beyer J, Liersch R. Combination chemotherapy with gemcitabine plus oxaliplatin in patients with intensively pretreated or refractory germ cell cancer: a study of the German Testicular Cancer Study Group. J Clin Oncol 2004;22:108114.

    • Search Google Scholar
    • Export Citation
  • 38

    De Giorgi U, Rosti G, Aieta M. Phase II study of oxaliplatin and gemcitabine salvage chemotherapy in patients with cisplatin-refractory nonseminomatous germ cell tumor. Eur Urol 2006;50:10321038; discussion 1038–1039.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 306 141 13
PDF Downloads 159 94 10
EPUB Downloads 0 0 0