Testicular cancer medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{CMG}}; {{AE}} {{G.D.}}, {{SC}} | {{CMG}}; {{AE}} {{G.D.}}, {{SC}} | ||
{{Testicular cancer}} | {{Testicular cancer}} | ||
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==Medical Therapy== | ==Medical Therapy== | ||
Seminoma | ===Germ cell tumors=== | ||
Seminoma is sensitive to radiotherapy and chemotherapy. | [[Seminoma]]: | ||
Stage IA and IB | |||
*Surveillance for pT1-T3 tumors or | [[Seminoma]] is sensitive to [[radiotherapy]] and [[chemotherapy]]. | ||
*Single agent carboplatin for 1 or 2 cycles followed with chest | |||
* Radiation therapy | Stage IA and IB<ref name="OliverDieckmann2005">{{cite journal|last1=Oliver|first1=T.|last2=Dieckmann|first2=K.-P.|last3=Steiner|first3=H.|last4=Skoneczna|first4=I.|title=Pooled analysis of phase 2 reports of 2 v 1 course of carboplatin as adjuvant for stage 1 seminoma|journal=Journal of Clinical Oncology|volume=23|issue=16_suppl|year=2005|pages=4572–4572|issn=0732-183X|doi=10.1200/jco.2005.23.16_suppl.4572}}</ref> | ||
*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]]. <ref name="pmid27618772">{{cite journal |vauthors=Chovanec M, Hanna N, Cary KC, Einhorn L, Albany C |title=Management of stage I testicular germ cell tumours |journal=Nat Rev Urol |volume=13 |issue=11 |pages=663–673 |date=November 2016 |pmid=27618772 |doi=10.1038/nrurol.2016.164 |url=}}</ref><ref>"NCCN Clinical Practice Guidelines in Oncology: Testicular cancer. National comprehensive cancer network, 2019; https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf."</ref> | |||
* [[Radiation therapy]] | |||
Stage IS | Stage IS | ||
*Recheck the serum marker and the chest X-ray and Ct scan of abdomen and pelvis | *Recheck the [[serum]] [[marker]] and the [[Chest X-rays|chest X-ray]] and [[Ct scan]] of [[abdomen]] and [[pelvis]]. | ||
Stage IIA | Stage IIA | ||
*[[Bleomycin]], [[etoposide]], and [[cisplatin]] for 3 cycles or [[etoposide]], and [[cisplatin]] for 4 cycles. | *[[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 | Stage IIB or IIC | ||
*[[Bleomycin]], [[etoposide]], and [[cisplatin]] for 3 cycles or [[etoposide]], and [[cisplatin]] for 4 cycles. | *[[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=== | ||
* [[Radiation therapy]] works best for | * [[Radiation therapy]] works best for [[seminoma]]. [[Nonseminoma|Non-seminoma]] do not respond well to [[radiation therapy]]. | ||
* [[External beam radiotherapy|External beam radiation]] may be used for stage I and most stage II seminomas after [[orchiectomy]]. | * [[External beam radiotherapy|External beam radiation]] may be used for stage I and most stage II [[Seminoma|seminomas]] after [[orchiectomy]].<ref name="pmid22436787">{{cite journal |vauthors=Wilder RB, Buyyounouski MK, Efstathiou JA, Beard CJ |title=Radiotherapy treatment planning for testicular seminoma |journal=Int. J. Radiat. Oncol. Biol. Phys. |volume=83 |issue=4 |pages=e445–52 |date=July 2012 |pmid=22436787 |doi=10.1016/j.ijrobp.2012.01.044 |url=}}</ref> | ||
* Radiation therapy after | * [[Radiation therapy]] after [[orchiectomy]] including the [[Paraaortic lymph nodes|para-aortic]] and ipsilateral [[iliac lymph nodes]] for stage IIA [[Seminoma|seminoma.]]<ref>"NCCN Clinical Practice Guidelines in Oncology: Testicular cancer. National comprehensive cancer network, 2019; https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf."</ref> | ||
* Radiation therapy in selected non bulky (3 cm or < | * [[Radiation therapy]] in selected non bulky (3 cm or < 3 cm) including the [[Paraaortic lymph node|para-aortic]] and ipsilateral [[iliac lymph nodes]] for [[Seminoma|stage IIB seminoma]].<ref>"NCCN Clinical Practice Guidelines in Oncology: Testicular cancer. National comprehensive cancer network, 2019; https://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf."</ref><ref name="pmid12637477">{{cite journal |vauthors=Classen J, Schmidberger H, Meisner C, Souchon R, Sautter-Bihl ML, Sauer R, Weinknecht S, Köhrmann KU, Bamberg M |title=Radiotherapy for stages IIA/B testicular seminoma: final report of a prospective multicenter clinical trial |journal=J. Clin. Oncol. |volume=21 |issue=6 |pages=1101–6 |date=March 2003 |pmid=12637477 |doi=10.1200/JCO.2003.06.065 |url=}}</ref> | ||
* Radiation treatments are usually given once a day, 5 days a week, for 2–4 weeks. | * [[Radiation]] [[treatments]] are usually given once a day, 5 days a week, for 2–4 weeks. | ||
===Chemotherapy=== | ===Chemotherapy=== | ||
'''Standard-dose chemotherapy''' | '''Standard-dose chemotherapy'''<ref name="pmid9053482">{{cite journal |vauthors= |title=International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group |journal=J. Clin. Oncol. |volume=15 |issue=2 |pages=594–603 |date=February 1997 |pmid=9053482 |doi=10.1200/JCO.1997.15.2.594 |url=}}</ref><ref name="pmid18936476">{{cite journal |vauthors=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 |title=Chemotherapy as an alternative to radiotherapy in the treatment of stage IIA and IIB testicular seminoma: a Spanish Germ Cell Cancer Group Study |journal=J. Clin. Oncol. |volume=26 |issue=33 |pages=5416–21 |date=November 2008 |pmid=18936476 |doi=10.1200/JCO.2007.15.9103 |url=}}</ref> | ||
* The most common [[chemotherapy]] combinations used to treat testicular cancer are: | * The most common [[chemotherapy]] combinations used to treat testicular cancer are: | ||
:* [[Bleomycin]], [[etoposide]], and [[cisplatin]] | :* [[Bleomycin]], [[etoposide]], and [[cisplatin]] | ||
::* 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. | ::* It is usually given IV every 3 weeks for 3 months for 3 cycles for [[metastasis]] to [[brain]], stage IIA, IIB, IIC, and good risk stage III [[seminoma]] as well as good risk stage IIA, IIB, and stage IIC, IIIA [[Nonseminoma]]. | ||
:* [[Etoposide]] and [[cisplatin]] for 4 cycles for stage IIA, | :* [[Etoposide]] and [[cisplatin]] are given for 4 cycles for [[metastasis]] to [[brain]], stage IIA, IIB, IIC and good risk stage III [[seminoma]] as well as good risk stage IIA, IIB, and stage IIC, IIIA [[Nonseminoma]].<ref name="pmid2446132">{{cite journal |vauthors=Williams SD, Stablein DM, Einhorn LH, Muggia FM, Weiss RB, Donohue JP, Paulson DF, Brunner KW, Jacobs EM, Spaulding JT |title=Immediate adjuvant chemotherapy versus observation with treatment at relapse in pathological stage II testicular cancer |journal=N. Engl. J. Med. |volume=317 |issue=23 |pages=1433–8 |date=December 1987 |pmid=2446132 |doi=10.1056/NEJM198712033172303 |url=}}</ref> | ||
::* It is used when bleomycin affects the lungs or there is a high risk that it will cause lung damage. | ::* 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]] and intermediate and poor risk stage IIIC [[Nonseminoma]]. | ||
::* [[Bleomycin]], [[etoposide]], and [[cisplatin]] for 1 cycle for stage I [[nonseminoma]] with and without [[risk factors]].<ref name="pmid19875756">{{cite journal |vauthors=Kollmannsberger C, Moore C, Chi KN, Murray N, Daneshmand S, Gleave M, Hayes-Lattin B, Nichols CR |title=Non-risk-adapted surveillance for patients with stage I nonseminomatous testicular germ-cell tumors: diminishing treatment-related morbidity while maintaining efficacy |journal=Ann. Oncol. |volume=21 |issue=6 |pages=1296–301 |date=June 2010 |pmid=19875756 |doi=10.1093/annonc/mdp473 |url=}}</ref> | |||
* 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. | * 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 | :* [[Paclitaxel]], [[ifosfamide]] and [[cisplatin]] | ||
::* It is given IV every 3 weeks for 3 months, or 4 cycles. | ::* It is given IV every 3 weeks for 3 months, or 4 cycles. | ||
:* Etoposide, ifosfamide and cisplatin | :* [[Etoposide]], [[ifosfamide]] and [[cisplatin]] | ||
::* It is given IV every 3 weeks for 3 months, or 4 cycles. | ::* It is given IV every 3 weeks for 3 months, or 4 cycles. | ||
:* Etoposide or [[vinblastine]], ifosfamide and cisplatin | :* [[Etoposide]] or [[vinblastine]], [[ifosfamide]] and [[cisplatin]] | ||
::* It is given IV every 3 weeks for 3 months, or 4 cycles. | ::* It is given IV every 3 weeks for 3 months, or 4 cycles. | ||
'''High-dose chemotherapy''' | '''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. | * 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 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. | * [[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 [[Seminoma|seminomas]] or [[Nonseminoma|non-seminoma]]. | ||
|} | ===Sex cord stromal testicular tumors=== | ||
*Most [[sex cord]] stromal testicular tumors may not respond to [[chemotherapy]] and [[radiation]].<ref name="pmid16097561">{{cite journal |vauthors=Conkey DS, Howard GC, Grigor KM, McLaren DB, Kerr GR |title=Testicular sex cord-stromal tumours: the Edinburgh experience 1988-2002, and a review of the literature |journal=Clin Oncol (R Coll Radiol) |volume=17 |issue=5 |pages=322–7 |date=August 2005 |pmid=16097561 |doi= |url=}}</ref><ref name="pmid10971169">{{cite journal |vauthors=Farkas LM, Székely JG, Pusztai C, Baki M |title=High frequency of metastatic Leydig cell testicular tumours |journal=Oncology |volume=59 |issue=2 |pages=118–21 |date=August 2000 |pmid=10971169 |doi=10.1159/000012147 |url=}}</ref> | |||
*[[Adjuvants]] are not helpful nor effective. | |||
==References== | ==References== | ||
Latest revision as of 15:13, 28 May 2019
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
Germ cell tumors
Seminoma is sensitive to radiotherapy and chemotherapy.
Stage IA and IB[1]
- 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. [2][3]
- Radiation therapy
Stage IS
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 seminoma. Non-seminoma do not respond well to radiation therapy.
- External beam radiation may be used for stage I and most stage II seminomas after orchiectomy.[4]
- Radiation therapy after orchiectomy including the para-aortic and ipsilateral iliac lymph nodes for stage IIA seminoma.[5]
- Radiation therapy in selected non bulky (3 cm or < 3 cm) including the para-aortic and ipsilateral iliac lymph nodes for stage IIB seminoma.[6][7]
- Radiation treatments are usually given once a day, 5 days a week, for 2–4 weeks.
Chemotherapy
Standard-dose chemotherapy[8][9]
- 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 metastasis to brain, stage IIA, IIB, IIC, and good risk stage III seminoma as well as good risk stage IIA, IIB, and stage IIC, IIIA Nonseminoma.
- Etoposide and cisplatin are given for 4 cycles for metastasis to brain, stage IIA, IIB, IIC and good risk stage III seminoma as well as good risk stage IIA, IIB, and stage IIC, IIIA Nonseminoma.[10]
- Bleomycin, etoposide, and cisplatin or etoposide, mesna, ifosfamide, and cisplatin are given for 4 cycles for intermediate risk stage III seminoma and intermediate and poor risk stage IIIC Nonseminoma.
- Bleomycin, etoposide, and cisplatin for 1 cycle for stage I nonseminoma with and without risk factors.[11]
- 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.
-
- 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.
Sex cord stromal testicular tumors
- Most sex cord stromal testicular tumors may not respond to chemotherapy and radiation.[12][13]
- Adjuvants are not helpful nor effective.
References
- ↑ Oliver, T.; Dieckmann, K.-P.; Steiner, H.; Skoneczna, I. (2005). "Pooled analysis of phase 2 reports of 2 v 1 course of carboplatin as adjuvant for stage 1 seminoma". Journal of Clinical Oncology. 23 (16_suppl): 4572–4572. doi:10.1200/jco.2005.23.16_suppl.4572. ISSN 0732-183X.
- ↑ 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."
- ↑ Classen J, Schmidberger H, Meisner C, Souchon R, Sautter-Bihl ML, Sauer R, Weinknecht S, Köhrmann KU, Bamberg M (March 2003). "Radiotherapy for stages IIA/B testicular seminoma: final report of a prospective multicenter clinical trial". J. Clin. Oncol. 21 (6): 1101–6. doi:10.1200/JCO.2003.06.065. PMID 12637477.
- ↑ "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.
- ↑ Williams SD, Stablein DM, Einhorn LH, Muggia FM, Weiss RB, Donohue JP, Paulson DF, Brunner KW, Jacobs EM, Spaulding JT (December 1987). "Immediate adjuvant chemotherapy versus observation with treatment at relapse in pathological stage II testicular cancer". N. Engl. J. Med. 317 (23): 1433–8. doi:10.1056/NEJM198712033172303. PMID 2446132.
- ↑ Kollmannsberger C, Moore C, Chi KN, Murray N, Daneshmand S, Gleave M, Hayes-Lattin B, Nichols CR (June 2010). "Non-risk-adapted surveillance for patients with stage I nonseminomatous testicular germ-cell tumors: diminishing treatment-related morbidity while maintaining efficacy". Ann. Oncol. 21 (6): 1296–301. doi:10.1093/annonc/mdp473. PMID 19875756.
- ↑ Conkey DS, Howard GC, Grigor KM, McLaren DB, Kerr GR (August 2005). "Testicular sex cord-stromal tumours: the Edinburgh experience 1988-2002, and a review of the literature". Clin Oncol (R Coll Radiol). 17 (5): 322–7. PMID 16097561.
- ↑ Farkas LM, Székely JG, Pusztai C, Baki M (August 2000). "High frequency of metastatic Leydig cell testicular tumours". Oncology. 59 (2): 118–21. doi:10.1159/000012147. PMID 10971169.