Testicular Germ Cell Tumors: Treatment by Stage

Testicular Germ Cell Tumors: Treatment by Stage: overview

This algorithm outlines management of testicular germ cell tumors after orchiectomy, branching first by histology and stage, then by IGCCCG risk group for advanced disease. For stage I seminoma, surveillance is preferred, with single-agent carboplatin or adjuvant radiotherapy as alternatives. For stage I non-seminoma, surveillance is likewise preferred, with one cycle of adjuvant BEP or nerve-sparing retroperitoneal lymph node dissection (RPLND) as alternatives.

Advanced disease is stratified by IGCCCG risk. Good-risk patients receive three cycles of BEP (bleomycin, etoposide, cisplatin) or four cycles of EP. Intermediate or poor risk patients receive four cycles of BEP, or four cycles of VIP when bleomycin is contraindicated. For relapsed or refractory disease, the chart shows TIP salvage chemotherapy or high-dose chemotherapy with autologous stem-cell rescue (TI-CE). The chart does not link individual trials to these branches.

Step by step

• Stage I seminoma: surveillance preferred, or single-agent carboplatin or adjuvant radiotherapy.
• Stage I non-seminoma: surveillance preferred, or one cycle of adjuvant BEP or nerve-sparing RPLND.
• Advanced disease, IGCCCG good risk: three cycles of BEP or four cycles of EP.
• Advanced disease, IGCCCG intermediate or poor risk: four cycles of BEP, or four cycles of VIP if bleomycin is contraindicated.
• Relapsed or refractory disease: TIP salvage chemotherapy, or high-dose chemotherapy with autologous stem-cell rescue (TI-CE).

Background reading: Testicular Cancer board review notes.