Management of clinical stage I nonseminomatous germ cell tumors

• Published in: Expert review of anticancer therapy Vol. 14; no. 9; pp. 1021 - 1032
• Main Authors: Isharwal, Sumit, Risk, Michael C
• Format: Journal Article
• Language: English
• Published: London Informa UK, Ltd 01.09.2014; Taylor & Francis; Future Drugs; Informa Healthcare
• Subjects: active surveillance; adjuvant chemotherapy; Antineoplastic agents; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Chemotherapy, Adjuvant - methods; Gynecology. Andrology. Obstetrics; Humans; Lymph Node Excision - methods; Male genital diseases; Medical sciences; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Neoplasms, Germ Cell and Embryonal - pathology; Neoplasms, Germ Cell and Embryonal - therapy; non-seminomatous germ cell tumor; Patient Compliance; Patient Preference; Pharmacology. Drug treatments; retroperitoneal lymph node dissection; Risk; Survival Rate; testicular cancer; Testicular Neoplasms; Tumors; adjuvant chemotherapy; non-seminomatous germ cell tumor; Retroperitoneal; Adjuvant treatment; Early stage; Non seminomatous tumor; Malignant tumor; Germ cell tumor; testicular cancer; Lymphadenectomy; Chemotherapy; Clinical stage; Treatment; Clinical management; Surveillance; retroperitoneal lymph node dissection; Surgery; Male genital diseases; Testicular diseases; Testicle cancer; active surveillance; Cancer
• ISSN: 1473-7140; 1744-8328
• DOI: 10.1586/14737140.2014.928593

Therapeutic options for clinical stage I nonseminomatous germ cell tumor include active surveillance, adjuvant chemotherapy and retroperitoneal lymph node dissection (RPLND). Lymphovascular invasion (LVI) determines risk of recurrence, as those without LVI have 15% risk of relapse on surveillance while those with LVI have a 50% risk. This stratifies patients into high risk(LVI+) and low risk(LVI-) groups which direct treatment recommendations. Surveillance is preferred for those with low risk disease, and is an option for those with high risk disease, as at least half are over-treated with other options. Adjuvant chemotherapy is an option for all patients as it can eradicate micrometastatic disease and reduce recurrence by at least 90%. RPLND benefits patients with low volume retroperitoneal disease with a cure rate of RPLND alone at approximately 70%. All three treatment modalities have similar survival rates approaching 100% but differing potential morbidities, which, along with patient preferences and compliance, should guide treatment decisions.