Medication Summary
Chemotherapy Regimens
Chemotherapy regimens for testicular cancers are divided into initial and salvage chemotherapy, according to tumor stage, status, and risk stratification.
Initial Chemotherapy Regimens
Carboplatin (for stage I seminoma)
Carboplatin AUC 7 x 1 cycle or 2 cycles
BEP (5-day schedule)
Bleomycin 30 U or 30 mg IV bolus day 1, 8, 15 or day 2, 9, 16
Etoposide (VP-16) 100 mg/m2/day IV for five days
Cisplatin (CDDP) 20 mg/m2/day IV for five days
This regimen is administered for 3 to 4 cycles at 21-day intervals
EP
Etoposide (VP-16) 100 mg/m2/day IV daily for five days
Cisplatin (CDDP) 20 mg/m2/day IV daily for five days
This regimen is administered for 4 cycles at 21-day intervals
VIP (for patients with underlying lung disease)
Etoposide (VP-16) 75 mg/m2/day IV daily for five days
Ifosfamide 1.2 g/m2/day IV daily for five days
Cisplatin (CDDP) 20 mg/m2/day IV for days one through five
Mesna 120 mg/m2 slow IV bolus is given before ifosfamide day one, followed by 1,200 mg/m2/day continuous infusion on days one through five
This regimen is administered for 4 cycles at 21-day intervals
Salvage Chemotherapy Regimens
VeIP (for patients who received prior etoposide)
Vinblastine 0.11 mg/kg/ IV daily for 2 days
Ifosfamide 1,200 mg/m2 IV daily for five days
Mesna 400 mg/m2 IV every 8 hours for 5 days
Cisplatin (CDDP) 20 mg/m2 IV daily for five days
This regimen is administered for 4 cycles at 21-day intervals
TIP
Paclitaxel 250 mg/m2 IV day one followed by Ifosfamide 1500mg/m2 IV daily days 2-5 and Cisplatin (CDDP) 25 mg/m2 IV daily on days 2-5
Mesna 500 mg/m2 IV before ifosfamide, and then 4 and 8 hrs after each dose of ifosfamide daily on days 2-5
This regimen is administered for 4 cycles at 21-day intervals
GEMOX (palliative second line)
Gemcitabine 1,000 or 1,250 mg/m2 IV on days 1 and 8, plus oxaliplatin 130 mg/m2 IV on day 1 administered every 3 weeks
Antineoplastic Agent, Irritant
Etoposide
Glycosidic derivative of podophyllotoxin that exerts its cytotoxic effect through stabilization of the normally transient covalent intermediates formed between DNA substrate and topoisomerase II, leading to single- and double-strand DNA breaks. This causes cell proliferation to arrest in late S or early G2 portion of the cell cycle.
Therapy should be withheld or suspended if platelet counts are < 50,000 or absolute neutrophil counts are < 500/mm3. Reduce dose 20% for granulocytic fever or previous radiotherapy. Reduce dose in hepatic (increased total bilirubin [TB]) and renal (decreased CrCl) impairment.
Antineoplastic Agent, Antibiotic
Bleomycin
Group of glycopeptides extracted from Streptomyces species. Each molecule has a planar end and an amine end; different glycopeptides of the group differ in their terminal amine moieties. Planar end intercalates with DNA, while amine end facilitates oxidation of bound ferrous ions to ferric ions, thereby generating free radicals, which subsequently cleave DNA, acting specifically at purine-G-C-pyrimidine sequences.
Not absorbed when given orally; peak levels reached in about 30-60 min when given IM and are only one third of levels obtained after IV administration; approximately 50% of drug absorbed systemically after intrapleural or intraperitoneal administration; systemic absorption after intracavitary administration for craniopharyngioma not negligible.
Volume of distribution is 20-30 L both in intracellular and extracellular fluid.
Less than 10% is bound to plasma proteins.
Bleomycin has plasma half-life of less than 1 h and terminal half-life of 2-4 h, but it could be as long as 22 h in patients with renal dysfunction or those previously treated with cisplatin.
About 50% eliminated in urine within 24 h. Most tissues (known exceptions—skin and lungs) contain an enzyme, bleomycin hydrolase (most active tissues are liver and kidney), which readily inactivates drug; therefore, toxicity is tissue specific, occurring in tissues lacking this enzyme. Bleomycin mostly used systemically in combination with other drugs (mostly with cisplatin and vincristine).
Principal mechanisms of resistance include high levels of bleomycin hydrolase, cell mutations altering DNA sequences to prevent intercalation, poor cell accumulation of drug, and rapid plasma removal. None of these factors plays important role when bleomycin administered locally in residual cyst.
Toxicity is age dependent and cumulative dose related; systemic administration mostly causes pulmonary toxicity. This consists of pneumonitis, which can progress to fatal pulmonary fibrosis.
Maximum recommended total cumulative dose for systemic use is 400 U. Unit measurement based on toxicity to bacteria; 1 U equals approximately 1.7 mg.
Administered systemically, does not produce significant bone marrow toxicity. Toxicity with local administration due to both systemic contamination (when anaphylactoid reactions, transient fever, nausea, and vomiting could occur) and leakage into surrounding neural tissue. Fatal outcome has been reported with leakage, due to subsequent diffuse diencephalon and brainstem edema.
Contrast CT cystography is required prior to intracavitary administration to ensure cyst wall integrity; when inconclusive, MR cystography with gadopentetate dimeglumine has been advocated.
Antineoplastic Agent, Alkylating Agent
Cisplatin
Platinum-containing compound that exerts antineoplastic effect by covalently binding to DNA with preferential binding to N-7 position of guanine and adenosine. Can react with 2 different sites on DNA to cause cross-links. Platinum complex also can bind to nucleus and cytoplasmic protein. A bifunctional alkylating agent, once activated to aquated form in cell, binds to DNA, resulting in interstrand and intrastrand cross-linking and denaturation of double helix.
Modify dose on basis of CrCl. Avoid use if CrCl < 60 mL/min.
Ifosfamide
Alkylating agent activated in liver to phosphoramide mustard and acrolein. Phosphoramide mustard cross-links DNA strands and is responsible for therapeutic effect. Acrolein related to bladder toxicity.
Oxaliplatin
Platinum-based antineoplastic agent forms interstrand and intrastrand Pt-DNA crosslinks that inhibit DNA replication and transcription. Cytotoxicity is cell-cycle nonspecific.
Carboplatin
Analog of cisplatin. This is a heavy metal coordination complex that exerts its cytotoxic effect by platination of DNA, a mechanism analogous to alkylation, leading to interstrand and intrastrand DNA crosslinks and inhibition of DNA replication. Binds to protein and other compounds containing SH group. Cytotoxicity can occur at any stage of the cell cycle, but cell is most vulnerable to action of these drugs in G1 and S phase.
Has same efficacy as cisplatin but with better toxicity profile. Main advantages over cisplatin include less nephrotoxicity and ototoxicity not requiring extensive prehydration, less likely to induce nausea and vomiting, but more likely to induce myelotoxicity.
Dose is based on the following formula: total dose (mg) = (target AUC) x (GFR+25) where AUC (area under plasma concentration-time curve) is expressed in mg/mL/min and GFR (glomerular filtration rate) is expressed in mL/min.
Antineoplastic Agent, Antimicrotubular
Antineoplastic Agent, Vesicant
Vinblastine
Vinca alkaloid, inhibits microtubule formation, which disrupts formation of mitotic spindle, causing cell proliferation to arrest at metaphase.
Antineoplastic Agent, Antimetabolite
Gemcitabine
Cytidine analog, after intracellular metabolism to active nucleotide, inhibits ribonucleotide reductase and competes with deoxycytidine triphosphate for incorporation into DNA. Cell-cycle specific for S phase.
This drug has been shown to have activity in a phase 2 trial against relapsed germ cell tumors.
American Cancer Society. Cancer facts and figures 2009. Available at http://www.cancer.org/downloads/STT/500809web.pdf. Accessed July 11, 2009.
McGlynn KA, Devesa SS, Sigurdson AJ, Brown LM, Tsao L, Tarone RE. Trends in the incidence of testicular germ cell tumors in the United States. Cancer. Jan 1 2003;97(1):63-70. [Medline].
McGlynn KA, Devesa SS, Graubard BI, Castle PE. Increasing incidence of testicular germ cell tumors among black men in the United States. J Clin Oncol. Aug 20 2005;23(24):5757-61. [Medline].
Pettersson A, Richiardi L, Nordenskjold A, Kaijser M, Akre O. Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med. May 3 2007;356(18):1835-41. [Medline].
Walsh TJ, Croughan MS, Schembri M, Chan JM, Turek PJ. Increased risk of testicular germ cell cancer among infertile men. Arch Intern Med. Feb 23 2009;169(4):351-6. [Medline].
American Joint Committee on Cancer. Testis. In: AJCC Cancer Staging Manual. 6th edition. New York: Springer Science Business Media LCC; 2006.
International Germ Cell Cancer Collaborative Group. International Germ Cell Consensus Classification: a prognostic factor- based staging system for metastatic germ cell cancers. J Clin Oncol. Feb 1997;15(2):594-603. [Medline].
Kollmannsberger C, Tyldesley S, Moore C, et al. Evolution in management of testicular seminoma: population-based outcomes with selective utilization of active therapies. Ann Oncol. Apr 2011;22(4):808-14. [Medline].
Mead GM, Fossa SD, Oliver RT, Joffe JK, Huddart RA, Roberts JT, et al. Randomized Trials in 2466 Patients With Stage I Seminoma: Patterns of Relapse and Follow-up. J Natl Cancer Inst. Feb 2 2011;103(3):241-249. [Medline].
Oliver RT, Mason MD, Mead GM, von der Maase H, Rustin GJ, Joffe JK. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet. Jul 23-29 2005;366(9482):293-300. [Medline].
Oliver RT, Mead GM, Fogarty PJ, Stenning SP, MRC TE19 and EORTC 30982 trial collaborators. Radiotherapy versus carboplatin for stage I seminoma: Updated analysis of the MRC/EORTC randomized trial (ISRCTN27163214). J Clin Oncol. May 20 2008;26 suppl:abstract 1. [Full Text].
De Santis M, Becherer A, Bokemeyer C, Stoiber F, Oechsle K, Sellner F. 2-18fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: an update of the prospective multicentric SEMPET trial. J Clin Oncol. Mar 15 2004;22(6):1034-9. [Medline].
Einhorn LH, Williams SD, Chamness A, Brames MJ, Perkins SM, Abonour R. High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors. N Engl J Med. Jul 26 2007;357(4):340-8. [Medline].
Pectasides D, Pectasides M, Farmakis D, Aravantinos G, Nikolaou M, Koumpou M. Gemcitabine and oxaliplatin (GEMOX) in patients with cisplatin-refractory germ cell tumors: a phase II study. Ann Oncol. Mar 2004;15(3):493-7. [Medline].
Jeruss JS, Woodruff TK. Preservation of fertility in patients with cancer. N Engl J Med. Feb 26 2009;360(9):902-11. [Medline].
Travis LB, Fosså SD, Schonfeld SJ, McMaster ML, Lynch CF, Storm H. Second cancers among 40,576 testicular cancer patients: focus on long-term survivors. J Natl Cancer Inst. Sep 21 2005;97(18):1354-65. [Medline].
van Dijk MR, Steyerberg EW, Habbema JD. Survival of non-seminomatous germ cell cancer patients according to the IGCC classification: An update based on meta-analysis. Eur J Cancer. May 2006;42(7):820-6. [Medline].
Albers P. Surgery is an essential part of salvage treatment in refractory germ cell tumors. Eur Urol. Nov 2006;50(5):893-4. [Medline].
Albers P, Siener R, Krege S, Schmelz HU, Dieckmann KP, Heidenreich A. Randomized phase III trial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the adjuvant treatment of clinical stage I Nonseminomatous testicular germ cell tumors: AUO trial AH 01/94 by the German Testicular Cancer Study Group. J Clin Oncol. Jun 20 2008;26(18):2966-72. [Medline].
Albqami N, Janetschek G. Laparoscopic retroperitoneal lymph-node dissection in the management of clinical stage I and II testicular cancer. J Endourol. Jul-Aug 2005;19(6):683-92; discussion 692. [Medline].
Aparicio J, Germà JR, García del Muro X, Maroto P, Arranz JA, Sáenz A. Risk-adapted management for patients with clinical stage I seminoma: the Second Spanish Germ Cell Cancer Cooperative Group study. J Clin Oncol. Dec 1 2005;23(34):8717-23. [Medline].
Bajorin DF, Sarosdy MF, Pfister DG, et al. Randomized trial of etoposide and cisplatin versus etoposide and carboplatin in patients with good-risk germ cell tumors: a multiinstitutional study. J Clin Oncol. Apr 1993;11(4):598-606. [Medline].
Beck SD, Foster RS, Bihrle R, Cheng L, Donohue JP. Does the histology of nodal metastasis predict systemic relapse after retroperitoneal lymph node dissection in pathological stage B1 germ cell tumors?. J Urol. Oct 2005;174(4 Pt 1):1287-90; discussion 1290. [Medline].
Beck SD, Foster RS, Bihrle R, Cheng L, Ulbright TM, Donohue JP. Impact of the number of positive lymph nodes on disease-free survival in patients with pathological stage B1 nonseminomatous germ cell tumor. J Urol. Jul 2005;174(1):143-5. [Medline].
Bedano PM, Brames MJ, Williams SD, Juliar BE, Einhorn LH. Phase II study of cisplatin plus epirubicin salvage chemotherapy in refractory germ cell tumors. J Clin Oncol. Dec 1 2006;24(34):5403-7. [Medline].
Beyer J, Kramar A, Mandanas R, Linkesch W, Greinix A, Droz JP. High-dose chemotherapy as salvage treatment in germ cell tumors: a multivariate analysis of prognostic variables. J Clin Oncol. Oct 1996;14(10):2638-45. [Medline].
Bokemeyer C. Bleomycin in testicular cancer: will pharmacogenomics improve treatment regimens?. J Clin Oncol. Apr 10 2008;26(11):1783-5. [Medline].
Bosl GJ, Chaganti RS. The use of tumor markers in germ cell malignancies. Hematol Oncol Clin North Am. Jun 1994;8(3):573-87. [Medline].
Bosl GJ, Motzer RJ. Testicular germ-cell cancer. N Engl J Med. Jul 24 1997;337(4):242-53. [Medline].
Calvert AH, Newell DR, Gumbrell LA, O'Reilly S, Burnell M, Boxall FE. Carboplatin dosage: prospective evaluation of a simple formula based on renal function. J Clin Oncol. Nov 1989;7(11):1748-56. [Medline].
Chaganti RS, Houldsworth J. Genetics and biology of adult human male germ cell tumors. Cancer Res. Mar 15 2000;60(6):1475-82. [Medline].
Chaganti RS, Rodriguez E, Bosl GJ. Cytogenetics of male germ-cell tumors. Urol Clin North Am. Feb 1993;20(1):55-66. [Medline].
Chaganti RS, Rodriguez E, Mathew S. Origin of adult male mediastinal germ-cell tumours. Lancet. May 7 1994;343(8906):1130-2. [Medline].
Chung PW, Warde PR, Panzarella T, Bayley AJ, Catton CN, Milosevic MF. Appropriate radiation volume for stage IIA/B testicular seminoma. Int J Radiat Oncol Biol Phys. Jul 1 2003;56(3):746-8. [Medline].
Classen J, Schmidberger H, Meisner C, Souchon R, Sautter-Bihl ML, Sauer R. Radiotherapy for stages IIA/B testicular seminoma: final report of a prospective multicenter clinical trial. J Clin Oncol. Mar 15 2003;21(6):1101-6. [Medline].
Classen J, Schmidberger H, Meisner C, Winkler C, Dunst J, Souchon R. Para-aortic irradiation for stage I testicular seminoma: results of a prospective study in 675 patients. A trial of the German testicular cancer study group (GTCSG). Br J Cancer. Jun 14 2004;90(12):2305-11. [Medline].
Corvin S, Sturm W, Schlatter E, Anastasiadis A, Kuczyk M, Stenzl A. Laparoscopic retroperitoneal lymph-node dissection with the waterjet is technically feasible and safe in testis-cancer patient. J Endourol. Sep 2005;19(7):823-6. [Medline].
Culine S, Kramar A, Théodore C, Geoffrois L, Chevreau C, Biron P. Randomized trial comparing bleomycin/etoposide/cisplatin with alternating cisplatin/cyclophosphamide/doxorubicin and vinblastine/bleomycin regimens of chemotherapy for patients with intermediate- and poor-risk metastatic nonseminomatous germ cell tumors: Genito-Urinary Group of the French Federation of Cancer Centers Trial T93MP. J Clin Oncol. Jan 20 2008;26(3):421-7. [Medline].
Daugaard G, Petersen PM, Rørth M. Surveillance in stage I testicular cancer. APMIS. Jan 2003;111(1):76-83; discussion 83-5. [Medline].
De Giorgi U, Rosti G, Aieta M, Testore F, Burattini L, Fornarini G. Phase II study of oxaliplatin and gemcitabine salvage chemotherapy in patients with cisplatin-refractory nonseminomatous germ cell tumor. Eur Urol. Nov 2006;50(5):1032-8; discussion 1038-9. [Medline].
de Wit R. Optimal management of retroperitoneal metastatic nonseminomatous testicular cancer: toward a better selection between scalpel and needle. J Clin Oncol. Dec 10 2007;25(35):5550-2. [Medline].
de Wit R, Roberts JT, Wilkinson PM, de Mulder PH, Mead GM, Fosså SD. Equivalence of three or four cycles of bleomycin, etoposide, and cisplatin chemotherapy and of a 3- or 5-day schedule in good-prognosis germ cell cancer: a randomized study of the European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group and the Medical Research Council. J Clin Oncol. Mar 15 2001;19(6):1629-40. [Medline].
de Wit R, Stoter G, Kaye SB, et al. Importance of bleomycin in combination chemotherapy for good-prognosis testicular nonseminoma: a randomized study of the European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group. J Clin Oncol. May 1997;15(5):1837-43. [Medline].
Donohue JP, Thornhill JA, Foster RS, et al. Primary retroperitoneal lymph node dissection in clinical stage A non- seminomatous germ cell testis cancer. Review of the Indiana University experience 1965-1989. Br J Urol. Mar 1993;71(3):326-35. [Medline].
Einhorn LH. Role of the urologist in metastatic testicular cancer. J Clin Oncol. Mar 20 2007;25(9):1024-5. [Medline].
Feldman DR, Bosl GJ, Sheinfeld J, Motzer RJ. Medical treatment of advanced testicular cancer. JAMA. Feb 13 2008;299(6):672-84. [Medline].
Gels ME, Hoekstra HJ, Sleijfer DT, et al. Detection of recurrence in patients with clinical stage I nonseminomatous testicular germ cell tumors and consequences for further follow-up: a single-center 10-year experience. J Clin Oncol. May 1995;13(5):1188-94. [Medline].
Haugnes HS, Aass N, Fosså SD, Dahl O, Brydøy M, Aasebø U. Pulmonary function in long-term survivors of testicular cancer. J Clin Oncol. Jun 10 2009;27(17):2779-86. [Medline].
Hinton S, Catalano PJ, Einhorn LH, Nichols CR, David Crawford E, Vogelzang N. Cisplatin, etoposide and either bleomycin or ifosfamide in the treatment of disseminated germ cell tumors: final analysis of an intergroup trial. Cancer. Apr 15 2003;97(8):1869-75. [Medline].
Holm M, Hoei-Hansen CE, Rajpert-De Meyts E, Skakkebaek NE. Increased risk of carcinoma in situ in patients with testicular germ cell cancer with ultrasonic microlithiasis in the contralateral testicle. J Urol. Oct 2003;170(4 Pt 1):1163-7. [Medline].
Horvath A, Korde L, Greene MH, Libe R, Osorio P, Faucz FR, et al. Functional phosphodiesterase 11A mutations may modify the risk of familial and bilateral testicular germ cell tumors. Cancer Res. Jul 1 2009;69(13):5301-6. [Medline].
Houck W, Abonour R, Vance G, Einhorn LH. Secondary leukemias in refractory germ cell tumor patients undergoing autologous stem-cell transplantation using high-dose etoposide. J Clin Oncol. Jun 1 2004;22(11):2155-8. [Medline].
Huyghe E, Matsuda T, Thonneau P. Increasing incidence of testicular cancer worldwide: a review. J Urol. Jul 2003;170(1):5-11. [Medline].
Jones WG, Fossa SD, Mead GM, Roberts JT, Sokal M, Horwich A. Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I Testicular Seminoma: a report on Medical Research Council Trial TE18, European Organisation for the Research and Treatment of Cancer Trial 30942 (ISRCTN18525328). J Clin Oncol. Feb 20 2005;23(6):1200-8. [Medline].
Kollmannsberger C, Beyer J, Liersch R, Schoeffski P, Metzner B, Hartmann JT. Combination chemotherapy with gemcitabine plus oxaliplatin in patients with intensively pretreated or refractory germ cell cancer: a study of the German Testicular Cancer Study Group. J Clin Oncol. Jan 1 2004;22(1):108-14. [Medline].
Kollmannsberger C, Beyer J, Liersch R, Schoeffski P, Metzner B, Hartmann JT. Combination chemotherapy with gemcitabine plus oxaliplatin in patients with intensively pretreated or refractory germ cell cancer: a study of the German Testicular Cancer Study Group. J Clin Oncol. Jan 1 2004;22(1):108-14. [Medline].
Kondagunta GV, Bacik J, Bajorin D, Dobrzynski D, Sheinfeld J, Motzer RJ. Etoposide and cisplatin chemotherapy for metastatic good-risk germ cell tumors. J Clin Oncol. Dec 20 2005;23(36):9290-4. [Medline].
Kondagunta GV, Bacik J, Donadio A, Bajorin D, Marion S, Sheinfeld J. Combination of paclitaxel, ifosfamide, and cisplatin is an effective second-line therapy for patients with relapsed testicular germ cell tumors. J Clin Oncol. Sep 20 2005;23(27):6549-55. [Medline].
Loehrer PJ Sr, Bosl GJ. Carboplatin for stage I seminoma and the sword of Damocles. J Clin Oncol. Dec 1 2005;23(34):8566-9. [Medline].
Loehrer PJ Sr, Gonin R, Nichols CR, Weathers T, Einhorn LH. Vinblastine plus ifosfamide plus cisplatin as initial salvage therapy in recurrent germ cell tumor. J Clin Oncol. Jul 1998;16(7):2500-4. [Medline].
Loehrer PJ Sr, Johnson D, Elson P, et al. Importance of bleomycin in favorable-prognosis disseminated germ cell tumors: an Eastern Cooperative Oncology Group trial. J Clin Oncol. Feb 1995;13(2):470-6. [Medline].
Loehrer PJ Sr, Lauer R, Roth BJ, Williams SD, Kalasinski LA, Einhorn LH. Salvage therapy in recurrent germ cell cancer: ifosfamide and cisplatin plus either vinblastine or etoposide. Ann Intern Med. Oct 1 1988;109(7):540-6. [Medline].
Melchior D, Müller SC, Albers P. Extensive surgery in metastatic testicular cancer. Aktuelle Urol. Jul 2003;34(4):214-22. [Medline].
Motzer RJ, Agarwal N, Beard C, Bolger GB, Boston B, Carducci MA, et al. NCCN Clinical Practice Guidelines in Oncology: Testicular Cancer. J Natl Compr Canc Netw. Jun 2009;7(6):672-93. [Medline].
Motzer RJ, Rodriguez E, Reuter VE, et al. Molecular and cytogenetic studies in the diagnosis of patients with poorly differentiated carcinomas of unknown primary site. J Clin Oncol. Jan 1995;13(1):274-82. [Medline].
Motzer RJ, Sheinfeld J, Mazumdar M, et al. Etoposide and cisplatin adjuvant therapy for patients with pathologic stage II germ cell tumors. J Clin Oncol. Nov 1995;13(11):2700-4. [Medline].
Moynihan C, Norman AR, Barbachano Y, Burchell L, Huddart R, Dearnaley DP. Prospective study of factors predicting adherence to medical advice in men with testicular cancer. J Clin Oncol. May 1 2009;27(13):2144-50. [Medline].
Nichols CR, Catalano PJ, Crawford ED, Vogelzang NJ, Einhorn LH, Loehrer PJ. Randomized comparison of cisplatin and etoposide and either bleomycin or ifosfamide in treatment of advanced disseminated germ cell tumors: an Eastern Cooperative Oncology Group, Southwest Oncology Group, and Cancer and Leukemia Group B Study. J Clin Oncol. Apr 1998;16(4):1287-93. [Medline].
R. T. Oliver, G. M. Mead, P. J. Fogarty, S. P. Stenning, MRC TE19 and EORTC 30982 trial collaborators. Radiotherapy versus carboplatin for stage I seminoma: Updated analysis of the MRC/EORTC randomized trial (ISRCTN27163214). J Clin Oncol. 2008;26:(May 20 suppl; abstr 1).
Rick O, Bokemeyer C, Weinknecht S, Schirren J, Pottek T, Hartmann JT. Residual tumor resection after high-dose chemotherapy in patients with relapsed or refractory germ cell cancer. J Clin Oncol. Sep 15 2004;22(18):3713-9. [Medline].
Saxman SB, Finch D, Gonin R, Einhorn LH. Long-term follow-up of a phase III study of three versus four cycles of bleomycin, etoposide, and cisplatin in favorable-prognosis germ-cell tumors: the Indian University experience. J Clin Oncol. Feb 1998;16(2):702-6. [Medline].
Saxman SB, Nichols CR, Foster RS, et al. The management of patients with clinical stage I nonseminomatous testicular tumors and persistently elevated serologic markers. J Urol. Feb 1996;155(2):587-9. [Medline].
Shamash J, Stebbing J, Powles T. Germ-cell tumors. N Engl J Med. Oct 25 2007;357(17):1771-2; author reply 1773-4. [Medline].
Sheinfeld J, Motzer RJ. Stage I testicular cancer management and necessity for surgical expertise. J Clin Oncol. Jun 20 2008;26(18):2934-6. [Medline].
Tandstad T, Dahl O, Cohn-Cedermark G, Cavallin-Stahl E, Stierner U, Solberg A. Risk-adapted treatment in clinical stage I nonseminomatous germ cell testicular cancer: the SWENOTECA management program. J Clin Oncol. May 1 2009;27(13):2122-8. [Medline].
Thuret R, Cariou G, Aerts J, Cochand-Priollet B. Testicular sarcoidosis with elevated levels of cancer-associated markers. J Clin Oncol. Dec 20 2008;26(36):6007-8. [Medline].
Toner GC, Motzer RJ. Poor prognosis germ cell tumors: current status and future directions. Semin Oncol. Apr 1998;25(2):194-202. [Medline].
van Leeuwen FE, Stiggelbout AM, van den Belt-Dusebout AW, et al. Second cancer risk following testicular cancer: a follow-up study of 1,909 patients. J Clin Oncol. Mar 1993;11(3):415-24. [Medline].
Williams SD, Birch R, Einhorn LH, Irwin L, Greco FA, Loehrer PJ. Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med. Jun 4 1987;316(23):1435-40. [Medline].
Xiao H, Mazumdar M, Bajorin DF, Sarosdy M, Vlamis V, Spicer J. Long-term follow-up of patients with good-risk germ cell tumors treated with etoposide and cisplatin. J Clin Oncol. Jul 1997;15(7):2553-8. [Medline].
Zagars GK, Ballo MT, Lee AK, Strom SS. Mortality after cure of testicular seminoma. J Clin Oncol. Feb 15 2004;22(4):640-7. [Medline].
Subik MK, Gordetsky J, Yao JL, di Sant'agnese PA, Miyamoto H. Frozen section assessment in testicular and paratesticular lesions suspicious for malignancy: its role in preventing unnecessary orchiectomy. Hum Pathol. Mar 8 2012;[Medline].
| Incidence of Testicular Cancer by Race | |
| Race/Ethnicity | Annual rate per 100,000 men |
| All Races | 5.4 |
| White | 6.3 |
| Black | 1.3 |
| Asian/Pacific Islander | 1.7 |
| American Indian/Alaska Native | 4.6 |
| Hispanic | 4.0 |
| Stage | LDH | HCG (mIU/mL) | AFP (ng/mL) |
| S1 | < 1.5 times normal | < 5,000 | < 1,000 |
| S2 | 1.5-10 times normal | 5,000-50,000 | 1,000-10,000 |
| S3 | >10 times normal | >50,000 | >10,000 |
| LDH=lactate dehydrogenase; HCG=beta human chorionic gonadotropin; AFP=alpha fetoprotein. | |||
Print
