Skip to main content
SpringerLink
Log in

Advanced testis cancer

  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Advanced testis tumors are highly curable. The treatment strategy is chemotherapy followed by the surgical exeresis of residual disease. The standard chemotherapy regimen is BEP (bleomycin, etoposide, and cisplatin); the number of cycles of chemotherapy depends upon prognostic factors, based on the primary site, histology, presence of visceral metastases, and serum tumor marker levels. Patients in the good-risk group receive three cycles of chemotherapy , whereas those in the intermediate- and high-risk groups receive four cycles. Exeresis of all residual disease and systematic postchemotherapy retroperitoneal dissection in bulky disease are mandatory. When complete exeresis of necrotic tissue, teratoma, or active germ-cell cancer has been performed, no further postsurgical treatment is warranted. A multidisciplinary approach, rigorous administration of chemotherapy, and skill in surgery of germ-cell tumors are favored in the treatment of these patients in trained centers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Bosl GJ, Motzer RJ: Testicular germ-cell cancer. N Engl J Med 1997, 337:242–253. A very informative review of all aspects of germ-cell tumors.

    Article  PubMed  CAS  Google Scholar 

  2. Einhorn LH: Treatment of testicular cancer: a new and improved model. J Clin Oncol 1990, 8:1777–1781. “The alpha and the omega” on germ-cell tumor treatment by one of the major researchers on this topic.

    PubMed  CAS  Google Scholar 

  3. Culine S, Kramar A, Biron P, et al.: Chemotherapy in adult germ-cell tumors. Crit Rev Oncol Hematol 1996, 3:229–263.

    Article  Google Scholar 

  4. International Germ Cell Cancer Collaborative Group: International germ-cell consensus classification: a prognostic factor-based staging system for metastatic germ-cell cancers. J Clin Oncol 1997, 15:594–603. The basis of current prognostic staging system of germcell tumors.

    Google Scholar 

  5. Williams SD, Birch R, Einhorn LH, et al.: Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med 1987, 316:1435–1440. The first and most important contribution on germ-cell chemotherapy. Very little new information has been learned since this trial.

    Article  PubMed  CAS  Google Scholar 

  6. Saxman SB, Finch D, Gonin R, et al.: Long-term followup of a phase III study of three versus four cycles of bleomycin, etoposide, and cisplatin in favorableprognosis germ-cell tumors: the Indian University experience. J Clin Oncol 1998, 16:702–706.

    PubMed  CAS  Google Scholar 

  7. de Wit R, Stoter G, Kaye SB, et al.: Importance of bleomycin in combination chemotherapy for goodprognosis testicular nonseminoma: a randomized study of the European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group. J Clin Oncol 1997, 15:1837–1843.

    PubMed  Google Scholar 

  8. Bajorin DF, Sarosdy MF, Pfister DG, et al.: 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, 11:598–606.

    PubMed  CAS  Google Scholar 

  9. Loehrer PJ, Sr, Johnson D, Elson P, et al.: Importance of bleomycin in favorable-prognosis disseminated germ-cell tumors: an Eastern Cooperative Oncology Group trial. J Clin Oncol 1995, 13:470–476.

    PubMed  Google Scholar 

  10. Nichols CR, Williams SD, Loehrer PJ, et al.: Randomized study of cisplatin dose intensity in poor-risk germ-cell tumors: a Southeastern Cancer Study Group and Southwest Oncology Group protocol. J Clin Oncol 1991, 9:1163–1172.

    PubMed  CAS  Google Scholar 

  11. Nichols CR, Catalano PJ, Crawford ED, et al.: Randomized comparison of cisplatin and etoposide and either bleomycin or ifosfamide in treatment of advanced disseminated germ-cell tumors: an Eastern Cooperative Oncology Group, Southwest Oncology Group, and Cancer and Leukemia Group B Study. J Clin Oncol 1998, 16:1287–1293.

    PubMed  CAS  Google Scholar 

  12. Droz JP, Culine S, Biron P, et al.: High-dose chemotherapy in germ-cell tumors. Ann Oncol 1996, 7:997–1003.

    PubMed  CAS  Google Scholar 

  13. Loehrer PJ, Sr, Gonin R, Nichols CR, et al.: Vinblastine plus ifosfamide plus cisplatin as initial salvage therapy in recurrent germ-cell tumor. J Clin Oncol 1998, 16:2500–2504.

    PubMed  CAS  Google Scholar 

  14. Culine S, Droz JP: Comparative tolerability of chemotherapy regimens for germ-cell cancer. Drug Saf 2000, 22:373–388.

    Article  PubMed  CAS  Google Scholar 

  15. Puc HS, Heelan R, Mazumdar M, et al.: Management of residual mass in advanced seminoma: results and recommendations from the Memorial Sloan-Kettering Cancer Center. J Clin Oncol 1996, 14:454–460.

    PubMed  CAS  Google Scholar 

  16. Collette L, Sylvester RJ, Stenning SP, et al.: Impact of the treating institution on survival of patients with “poor-prognosis” metastatic nonseminoma. European Organization for Research and Treatment of Cancer Genito-Urinary Tract Cancer Collaborative Group and the Medical Research Council Testicular Cancer Working Party. J Natl Cancer Inst 1999, 91:839–846.

    Article  PubMed  CAS  Google Scholar 

  17. Horwich A, Paluchowska B, Norman A, et al.: Residual mass following chemotherapy of seminoma. Ann Oncol 1997, 8:37–40.

    Article  PubMed  CAS  Google Scholar 

  18. Culine S, Droz JP: Primary treatment in stage II non-seminomatous germ cell tumours of the testis: a matter of scalpel or drug infusion? Eur J Cancer 1996, 32A:1641–1644.

    Article  PubMed  CAS  Google Scholar 

  19. Toner GC, Panicek DM, Heelan RT, et al.: Adjunctive surgery after chemotherapy for nonseminomatous germ-cell tumors: recommendations for patient selection. J Clin Oncol 1990, 8:1683–1694. A very useful study that gives the basis for postchemotherapy surgery indications.

    PubMed  CAS  Google Scholar 

  20. Donohue JP, Foster RS, Rowland RG, et al.: Nervesparing retroperitoneal lymphadenectomy with preservation of ejaculation. J Urol 1990, 144:287–292.

    PubMed  CAS  Google Scholar 

  21. Baniel J, Foster RS, Rowland RG, et al.: Complications of primary retroperitoneal lymph node dissection. J Urol 1994, 152:424–427.

    PubMed  CAS  Google Scholar 

  22. Williams SD, Stablein DM, Einhorn LH, et al.: Immediate adjuvant chemotherapy versus observation with treatment at relapse in pathological stage II testicular cancer. N Engl J Med 1987, 317:1433–1438.

    Article  PubMed  CAS  Google Scholar 

  23. Coogan CL, Hejase MJ, Wahle GR, et al.: Nerve-sparing post-chemotherapy retroperitoneal lymph node dissection for advanced testicular cancer. J Urol 1996, 156:1656–658.

    Article  PubMed  CAS  Google Scholar 

  24. Wood DP, Jr, Herr HW, Heller G, et al.: Distribution of retroperitoneal metastases after chemotherapy in patients with nonseminomatous germ-cell tumors. J Urol 1992, 148:1812–1816.

    PubMed  Google Scholar 

  25. Aprikian AG, Herr HW, Bajorin DF, et al.: Resection of postchemotherapy residual masses and limited retroperitoneal lymphadenectomy in patients with metastatic testicular nonseminomatous germ-cell tumors. Cancer 1994, 74:1329–1334. The articles by Wood et al. [24] and Aprikian et al. [25] are exciting studies of experimental surgery in germ-cell tumors. They define limits of surgical exeresis of residual disease in the retroperitoneum depending on lymph-nodes, anatomy, and pathological findings.

    Article  PubMed  CAS  Google Scholar 

  26. Fizazi K, Tjulandin S, Salvioni R, et al.: Viable malignant cells after primary chemotherapy for disseminated nonseminomatous germ-cell tumors: prognostic factors and role of postsurgery chemotherapy —results from an international study group. J Clin Oncol 2001, 19:2647–2657.

    PubMed  CAS  Google Scholar 

  27. Xiao H, Liu D, Bajorin DF, et al.: Medical and surgical management of pulmonary metastases from germ-cell tumors. Chest Surg Clin N Am 1998, 8:131–143.

    PubMed  CAS  Google Scholar 

  28. Rivoire M, Elias D, de Cian F, et al.: Multimodality treatment of liver metastases from germ-cell tumors: the role of surgery. Cancer 2001. In press.

  29. de Wit R, Louwerens M, de Mulder PH, et al.: Management of intermediate-prognosis germ-cell cancer: results of a phase I/II study of Taxol-BEP. Int J Cancer 1999, 83:831–833.

    Article  PubMed  Google Scholar 

  30. Motzer RJ, Sheinfeld J, Mazumdar M, et al.: Paclitaxel, ifosfamide, and cisplatin second-line therapy for patients with relapsed testicular germ-cell cancer. J Clin Oncol 2000, 18:2413–2418.

    PubMed  CAS  Google Scholar 

  31. Motzer RJ, Mazumdar M, Sheinfeld J, et al.: Sequential dose-intensive paclitaxel, ifosfamide, carboplatin, and etoposide salvage therapy for germ-cell tumor patients. J Clin Oncol 2000, 18:1173–1180.

    PubMed  CAS  Google Scholar 

  32. Flechon A, Culine S, Droz JP: Intensive and timely chemotherapy, the key of success in testicular cancer. Crit Rev Oncol Hematol 2001, 37:35–46.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Centre Léon-Bérard, 28 rue Laënnec, 68008, Lyon, France

    Jean-Pierre Droz MD, PhD & Michel Rivoire MD, PhD

Authors
  1. Jean-Pierre Droz MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michel Rivoire MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Droz, JP., Rivoire, M. Advanced testis cancer. Curr. Treat. Options in Oncol. 2, 421–429 (2001). https://doi.org/10.1007/s11864-001-0047-z

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-001-0047-z

Keywords

Search

Navigation