Testicular cancer medical therapy
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
Seminoma:
Seminoma is sensitive to radiotherapy and chemotherapy. Stage IA and IB
- 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 [1][2]
- Radiation therapy
Stage IS
- Recheck the serum marker and the chest X-ray and Ct scan of abdomen and pelvis
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 seminomas. Non-seminomas do not respond well to radiation therapy.
- External beam radiation may be used for stage I and most stage II seminomas after orchiectomy.[3]
- Radiation therapy after ochiectomy including the para-aortic and ipsilateral iliac lymph nodes for stage IIA seminoma[4]
- Radiation therapy in selected non bulky (3 cm or < 3 cm) including the para-aortic and ipsilateral iliac lymph nodes for stage IIB seminoma.[5]
- Radiation treatments are usually given once a day, 5 days a week, for 2–4 weeks.
Chemotherapy
Standard-dose chemotherapy[6][7]
- 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 stage IIA, IIB, IIC, and good risk stage III seminoma.
- Etoposide and cisplatin are given for 4 cycles for stage IIA, IIB, IIC and good risk stage III seminoma
- It is used when bleomycin affects the lungs or there is a high risk that it will cause lung damage.
- Bleomycin, etoposide, and cisplatin or Etoposide, mesna, ifosfamide, and cisplatin are given for 4 cycles for intermediate risk stage III seminoma.
- It may be used when bleomycin affects the lungs or there is a high risk that it will cause lung damage. It is given IV every 3 weeks for 3 months, or 4 cycles.
- 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.
- Paclitaxel, ifosfamide and cisplatin
- 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.
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References
- ↑ 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."
- ↑ "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.