Current Update of Management of Clinical Stage I Non Seminomatous Germ Cell Tumors of Testis

Abstract

The management of patients with testicular germ cell tumors (GCT) has evolved significantly over the past 30 years with cure rates approaching nearly 100% for lowstage disease and more than 80% for advanced disease. Controversy surrounds about ideal management of clinical stage I non seminomatous germ cell tumors (CS I NSGCT) of the testis due to multiple treatment options available with more or less equal efficacy. Nerve-sparing retroperitoneal lymph node dissection (RPLND), adjuvant chemotherapy with two cycles of bleomycin, etoposide, and cisplatin , or surveillance have all achieved long-term survival in nearly 100% of patients with clinical stage I NSGCT. Retroperitoneal lymph node dissection is still favoured as the therapy of choice for clinical stage I non-seminomatous germ cell tumors in many centres, but as risk factors for the primary tumor have become better understood, surveillance and riskadapted therapy, including surveillance for low-risk patients and adjuvant chemotherapy for the high-risk group, is now being considered a therapeutic option. The objective of this study is to review current developments in the management of CS I NSGCT testis with emphasis on risk stratification and treatment recommendations.

Minimally Invasive Retroperitoneal Lymphadenectomy

“…6 However, up to 30% of these patients have occult metastases and will relapse if only surveillance is chosen after orchiectomy. 7 In large studies with high patient numbers, 80% of relapses occur during the first year of follow-up.…”

Postoperative Bleeding Ranks Highest among Complications after Retroperitoneal Lymph Node Dissection: Data from the National Surgical Quality Improvement Program

“…With currently available treatment modalities, the five-year survival rate is 95 per cent. 1 According to the National Comprehensive Cancer Network guidelines, retroperitoneal LN dissection (RPLND) is indicated in the management of stage I nonseminomatous germ cell tumors as adjuvant treatment in men with high-risk pathologic features, or those who cannot submit to surveillance schedules. 2 In addition, RPLND is used in stage II nonseminomatous germ cell tumors for pathologic staging to determine appropriate treatment.…”

“…Although testicular cancer represents the most common malignancy in males aged 20 to 39 years, the overall incidence is relatively low. 1 In an analysis of 162 patients undergoing RPLND (both primary and post-chemotherapy), 91 per cent of which were performed open, Wells et al 4 noted postoperative complications in 15 (9%) patients. Most of these were Clavien 1 or 2, and included wound infection, chest infection, lymph leak, and ileus.…”