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
Stage IIB
- Bleomycin, etoposide, and cisplatin for 3 cycles or etoposide, and cisplatin for 4 cycles.
- Radiation therapy in selected non bulky (3 cm or <3cm) including the para-aortic and ipsilateral iliac lymph nodes
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.
- Radiation therapy after ochiectomy including the para-aortic and ipsilateral iliac lymph nodes
- Radiation therapy in selected non bulky (3 cm or <3cm) including the para-aortic and ipsilateral iliac lymph nodes for stage IIB seminoma.
- Radiation treatments are usually given once a day, 5 days a week, for 2–4 weeks.
Chemotherapy
Standard-dose chemotherapy
- The most common chemotherapy combinations used to treat testicular cancer are:
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- 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 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.
- Etoposide, ifosfamide, and cisplatin
- 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."