Testicular cancer medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gertrude Djouka, M.D.[2], Shanshan Cen, M.D. [3]
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Overview
The predominant therapy for testicular cancer is surgical resection. Adjunctive chemotherapy and radiation therapy may be required.
Medical Therapy
Germ cell tumors
Seminoma is sensitive to radiotherapy and chemotherapy.
Stage IA and IB[1]
- Surveillance for pT1-T3 tumors or
- Single agent carboplatin for 1 or 2 cycles followed with chest x-ray and CT scan of the abdomen and pelvis. [2][3]
- Radiation therapy
Stage IS
Stage IIA
- Bleomycin, etoposide, and cisplatin for 3 cycles or etoposide, and cisplatin for 4 cycles.
- Low dose of radiation therapy is preferred over chemotherapy.
Stage IIB or IIC
- Bleomycin, etoposide, and cisplatin for 3 cycles or etoposide, and cisplatin for 4 cycles.
- Combined chemotherapy is recommended over radiation therapy.
Radiation therapy
- Radiation therapy works best for seminoma. Non-seminoma do not respond well to radiation therapy.
- External beam radiation may be used for stage I and most stage II seminomas after orchiectomy.[4]
- Radiation therapy after orchiectomy including the para-aortic and ipsilateral iliac lymph nodes for stage IIA seminoma.[5]
- Radiation therapy in selected non bulky (3 cm or < 3 cm) including the para-aortic and ipsilateral iliac lymph nodes for stage IIB seminoma.[6][7]
- Radiation treatments are usually given once a day, 5 days a week, for 2–4 weeks.
Chemotherapy
Standard-dose chemotherapy[8][9]
- The most common chemotherapy combinations used to treat testicular cancer are:
-
- It is usually given IV every 3 weeks for 3 months for 3 cycles for metastasis to brain, stage IIA, IIB, IIC, and good risk stage III seminoma as well as good risk stage IIA, IIB, and stage IIC, IIIA Nonseminoma.
- Etoposide and cisplatin are given for 4 cycles for metastasis to brain, stage IIA, IIB, IIC and good risk stage III seminoma as well as good risk stage IIA, IIB, and stage IIC, IIIA Nonseminoma.[10]
- Bleomycin, etoposide, and cisplatin or etoposide, mesna, ifosfamide, and cisplatin are given for 4 cycles for intermediate risk stage III seminoma and intermediate and poor risk stage IIIC Nonseminoma.
- Bleomycin, etoposide, and cisplatin for 1 cycle for stage I nonseminoma with and without risk factors.[11]
- If testicular cancer does not respond to the above drugs or if it recurs, the following chemotherapy combinations may be used. These are sometimes called salvage, or second-line, chemotherapy.
-
- It is given IV every 3 weeks for 3 months, or 4 cycles.
- Etoposide, ifosfamide and cisplatin
- It is given IV every 3 weeks for 3 months, or 4 cycles.
- Etoposide or vinblastine, ifosfamide and cisplatin
- It is given IV every 3 weeks for 3 months, or 4 cycles.
High-dose chemotherapy
- High-dose chemotherapy with carboplatin and etoposide may be used if testicular cancer recurs after it is treated with standard-dose chemotherapy.
Palliative chemotherapy
- Palliative therapy is given to relieve symptoms, rather than to treat the cancer itself. Gemcitabine may be given with oxaliplatin, paclitaxel or both as palliative treatment for seminomas or non-seminoma.
Sex cord stromal testicular tumors
- Most sex cord stromal testicular tumors may not respond to chemotherapy and radiation.[12][13]
- Adjuvants are not helpful nor effective.
References
- ↑ Oliver, T.; Dieckmann, K.-P.; Steiner, H.; Skoneczna, I. (2005). "Pooled analysis of phase 2 reports of 2 v 1 course of carboplatin as adjuvant for stage 1 seminoma". Journal of Clinical Oncology. 23 (16_suppl): 4572–4572. doi:10.1200/jco.2005.23.16_suppl.4572. ISSN 0732-183X.
- ↑ Chovanec M, Hanna N, Cary KC, Einhorn L, Albany C (November 2016). "Management of stage I testicular germ cell tumours". Nat Rev Urol. 13 (11): 663–673. doi:10.1038/nrurol.2016.164. PMID 27618772.
- ↑ "NCCN Clinical Practice Guidelines in Oncology: Testicular cancer. National comprehensive cancer network, 2019; https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf."
- ↑ Wilder RB, Buyyounouski MK, Efstathiou JA, Beard CJ (July 2012). "Radiotherapy treatment planning for testicular seminoma". Int. J. Radiat. Oncol. Biol. Phys. 83 (4): e445–52. doi:10.1016/j.ijrobp.2012.01.044. PMID 22436787.
- ↑ "NCCN Clinical Practice Guidelines in Oncology: Testicular cancer. National comprehensive cancer network, 2019; https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf."
- ↑ "NCCN Clinical Practice Guidelines in Oncology: Testicular cancer. National comprehensive cancer network, 2019; https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf."
- ↑ Classen J, Schmidberger H, Meisner C, Souchon R, Sautter-Bihl ML, Sauer R, Weinknecht S, Köhrmann KU, Bamberg M (March 2003). "Radiotherapy for stages IIA/B testicular seminoma: final report of a prospective multicenter clinical trial". J. Clin. Oncol. 21 (6): 1101–6. doi:10.1200/JCO.2003.06.065. PMID 12637477.
- ↑ "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. 15 (2): 594–603. February 1997. doi:10.1200/JCO.1997.15.2.594. PMID 9053482.
- ↑ Garcia-del-Muro X, Maroto P, Gumà J, Sastre J, López Brea M, Arranz JA, Lainez N, Soto de Prado D, Aparicio J, Piulats JM, Pérez X, Germá-Lluch JR (November 2008). "Chemotherapy as an alternative to radiotherapy in the treatment of stage IIA and IIB testicular seminoma: a Spanish Germ Cell Cancer Group Study". J. Clin. Oncol. 26 (33): 5416–21. doi:10.1200/JCO.2007.15.9103. PMID 18936476.
- ↑ Williams SD, Stablein DM, Einhorn LH, Muggia FM, Weiss RB, Donohue JP, Paulson DF, Brunner KW, Jacobs EM, Spaulding JT (December 1987). "Immediate adjuvant chemotherapy versus observation with treatment at relapse in pathological stage II testicular cancer". N. Engl. J. Med. 317 (23): 1433–8. doi:10.1056/NEJM198712033172303. PMID 2446132.
- ↑ Kollmannsberger C, Moore C, Chi KN, Murray N, Daneshmand S, Gleave M, Hayes-Lattin B, Nichols CR (June 2010). "Non-risk-adapted surveillance for patients with stage I nonseminomatous testicular germ-cell tumors: diminishing treatment-related morbidity while maintaining efficacy". Ann. Oncol. 21 (6): 1296–301. doi:10.1093/annonc/mdp473. PMID 19875756.
- ↑ Conkey DS, Howard GC, Grigor KM, McLaren DB, Kerr GR (August 2005). "Testicular sex cord-stromal tumours: the Edinburgh experience 1988-2002, and a review of the literature". Clin Oncol (R Coll Radiol). 17 (5): 322–7. PMID 16097561.
- ↑ Farkas LM, Székely JG, Pusztai C, Baki M (August 2000). "High frequency of metastatic Leydig cell testicular tumours". Oncology. 59 (2): 118–21. doi:10.1159/000012147. PMID 10971169.