To update the recommendations for the management of germ cell tumours of the testis.
Comprehensive PubMed review from 2022 on the diagnosis, treatment and follow-up of testicular germ cell tumours (TGT), as well as safety of treatments. The level of evidence of the studies was assessed.
The initial assessment of a patient with a germ cell tumour of the testis is based on a clinical examination, biological evaluation (by measuring the serum markers AFP, total hCG, and LDH) and radiological evaluation (scrotal ultrasound and thoraco-abdomino-pelvic computed tomography [TAP]). Inguinal orchiectomy is the first therapeutic step, as it allows histological diagnosis and defines the local stage and risk factors for progression in stage I nonseminomatous germ cell tumours (NSGCTs). For patients with pure stage I seminoma, the risk of progression is between 15 and 20%, so surveillance is preferred in compliant patients; adjuvant chemotherapy with carboplatin AUC 7 is an option; and the indications for lumbo-aortic radiotherapy are limited. For patients with stage I NSGCT, various options exist, namely, surveillance or a risk-adapted strategy (surveillance or 1 cycle of bleomycin etoposide cisplatin [BEP] depending on the presence or absence of vascular emboli within the tumour). Retroperitoneal lymph node dissection for staging has a very limited role. Treatment of metastatic GCT consists of chemotherapy with BEP in the absence of contraindication to bleomycin, the number of cycles of which is defined according to the prognostic groups of the International Germ Cell Cancer Consortium Group (IGCCCG). Lumbo-aortic radiotherapy is still the standard treatment for stage IIA seminomatous germ cell tumours (SGCTs). At the end of chemotherapy, the size of any residual mass should be assessed via a TAP scan for SNGCTs, with retroperitoneal lymph node dissection recommended for any residual mass greater than 1cm, along with removal of all other metastatic sites. For SGCT, reassessment via 18FDG PET scans is necessary to determine the surgical indication for residual masses>3cm. Surgery remains rare in these situations.
Adherence to the recommendations for the management of GCT results in excellent specific survival rates of 99% for patients with stage I disease and over 85% for patients with metastatic disease.
The French journal of urology. 2024 Nov [Epub]
Thibaut Murez, Aude Fléchon, Nicolas Branger, Pierre-Henri Savoie, Laurence Rocher, Philippe Camparo, Paul Neuville, Agathe Escoffier, Morgan Rouprêt
Comité de Cancérologie de l'Association Française d'Urologie, groupe organes génitaux externes, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Department of Urology and Renal Transplantation, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France. Electronic address: ., Comité de Cancérologie de l'Association Française d'Urologie, groupe organes génitaux externes, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Medical Oncology Department, Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France., Comité de Cancérologie de l'Association Française d'Urologie, groupe organes génitaux externes, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Hôpital Antoine-Béclère, Radiology Department, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France., Comité de Cancérologie de l'Association Française d'Urologie, groupe organes génitaux externes, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; BIOMAPS, UMR1281, Université Paris Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France., Comité de Cancérologie de l'Association Française d'Urologie, groupe organes génitaux externes, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Radiology Department, Hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France., Comité de Cancérologie de l'Association Française d'Urologie, groupe organes génitaux externes, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts de France, 51, rue Jeanne-d'Arc, 80000 Amiens, France., Comité de Cancérologie de l'Association Française d'Urologie, groupe organes génitaux externes, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Department of Urology, Hôpital Lyon Sud, Hospices Civils de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France., Comité de Cancérologie de l'Association Française d'Urologie, groupe organes génitaux externes, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Urology Department, Dijon University Hospital, 14, rue Paul-Gaffarel, 21000 Dijon, France., Comité de Cancérologie de l'Association Française d'Urologie, groupe organes génitaux externes, Maison de l'Urologie, 11, rue Viète, 75017 Paris, France; Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitié-Salpêtrière Hospital, 75013 Paris, France.