Germ Cell Tumors of the Testis
Survival in testicular cancer has improved dramatically over the past several years, reflecting the continuing improvement and refinement in combination chemotherapy.
For seminoma treated by orchiectomy and radiotherapy, the 5-year disease-free survival rate is 98% for stage I and 92-94% for stage II-A in several recent series. Higher-stage disease treated by orchiectomy and primary chemotherapy has a 5-year disease-free survival rate of 35-75%, yet the lower value comes from older series in which more crude chemotherapy regimens were employed.
Survival in patients with NSGCTs treated by orchiectomy and RPLND for stage A disease ranges from 96 to 100%. For low-volume stage B disease treated with chemotherapy plus surgery, greater than 90% 5-year disease-free survival rates are attainable. Patients with bulky retroperitoneal or disseminated disease treated with primary chemotherapy followed by surgery have a 5-year disease-free survival rate of 55-80%.
Currently much work is being done to stratify patients into “high-risk” and “low-risk” groups so that treatment regimens may be modified in order to increase survival and decrease morbidity.
All patients with testicular cancer require regular follow-up care. As discussed previously, patients on a surveillance protocol require vigorous follow-up. Those who have undergone surgery (RPLND) or radiotherapy are followed at 3-month intervals for the first 2 years, then every 6 months until 5 years, and then yearly. Follow-up visits should include careful examination of the remaining testis, the abdomen, and the lymph node areas. Laboratory investigation should include AFP, hCG, and LDH levels. A CXR and an abdominal film (if an LAG was performed) should also be included at each visit. Abdominal CT scans are used less frequently as risk of relapse in the retroperitoneum is low following RPLND.
Revision date: June 20, 2011
Last revised: by Jorge P. Ribeiro, MD