To update the recommendations for the management of germ cell tumours of the testis.
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
Cancerology Committee of the French Association of Urology, external genitalia group, Maison de l’Urologie, 11, rue Viète, 75017 Paris, France; Department of Urology and Renal Transplantation, Montpellier University Hospital, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France. Electronic address: ., Cancerology Committee of the French Association of Urology, external genitalia group, Maison de l’Urologie, 11, rue Viète, 75017 Paris, France; Medical Oncology Department, Center Léon-Bérard, 28, rue Laennec, 69008 Lyon, France., Cancerology Committee of the French Association of Urology, external genitalia group, Maison de l’Urologie, 11, rue Viète, 75017 Paris , France; Antoine-Béclère Hospital, Radiology Department, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France., Cancerology Committee of the French Association of Urology, external genitalia group, Maison de l’Urologie Urology, 11, rue Viète, 75017 Paris, France; BIOMAPS, UMR1281, Paris Saclay University, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France., Cancerology Committee of the French Association of Urology, external genitalia group, Maison de l’Urologie, 11, rue Viète, 75017 Paris, France; Radiology Department, Antoine-Béclère Hospital, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Paris Saclay University, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France., Cancerology Committee of the French Association of Urology, external genitalia group, Maison de l’Urologie, 11, rue Viète, 75017 Paris, France; Institute of Pathology of Hauts de France, 51, rue Jeanne-d’Arc, 80000 Amiens, France., Cancerology Committee of the French Association of Urology, external genitalia group, Maison de l’Urologie, 11, rue Viète , 75017 Paris, France; Department of Urology, Lyon Sud Hospital, Hospices Civils de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France., Cancerology Committee of the French Association of Urology, external genitalia group, Maison de l’Urologie Urology, 11, rue Viète, 75017 Paris, France; Urology Department, Dijon University Hospital, 14, rue Paul-Gaffarel, 21000 Dijon, France., Cancerology Committee of the French Association of Urology, external genitalia group, 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.
**The article mentions advancements in understanding the molecular basis of these tumours. How are these insights potentially impacting the development of new targeted therapies or personalised medicine approaches for germ cell tumours?**
## Interview: Germ Cell Tumours of the Testis – A Comprehensive Update
**Welcome to World Today News, where we delve into the latest advancements in healthcare. Today’s episode focuses on current recommendations for managing germ cell tumours of the testis, a critical topic with implications for patients worldwide.**
Joing us are two esteemed guests:
**Dr. [Guest 1 Name]**, a leading oncologist specializing in testicular cancer treatment, and
**Dr. [Guest 2 Name]**, a urologic surgeon with extensive experience in managing this condition.
**Thank you both for joining us today.**
**Section 1: Diagnostic Pathway & Initial Management**
* **Dr. [Guest 1 Name], the article highlights a multi-pronged approach to diagnosing testicular germ cell tumours. Could you walk us through this initial assessment process and its significance?**
* **Dr. [Guest 2 Name], the article emphasizes inguinal orchiectomy as the first therapeutic step. Can you explain the rationale behind this approach and what key information it provides for further treatment decisions?**
**Section 2: Treatment Strategies based on Stage & Histology**
* **Dr. [Guest 1 Name], the article differentiates between seminomatous and non-seminomatous germ cell tumours, outlining distinct treatment strategies based on stage. What are the key differences in these approaches and the reasoning behind them? **
* **Dr. [Guest 2 Name], we see a range of options presented for managing stage I nonseminomatous germ cell tumours, from surveillance to chemotherapy. Can you elaborate on the factors influencing the choice of treatment in these cases?**
**Section 3: Metastatic Disease and Advanced Care**
* **Dr. [Guest 1 Name], what are the preferred chemotherapy regimens for metastatic germ cell tumours, and how are they tailored to individual patient profiles based on prognostic factors?**
* **Dr. [Guest 2 Name], the article mentions the role of surgery in certain situations, even in the presence of residual masses after chemotherapy. Can you clarify the circumstances when surgery becomes a necessary component of treatment?**
**Section 4: Beyond Treatment: Long-Term Outcomes and Quality of Life**
* **Dr. [Guest 1 Name], the article highlights impressive survival rates for germ cell tumour patients. Could you discuss the factors that contribute to these positive outcomes, and what are some of the ongoing challenges in optimizing care?**
* **Dr. [Guest 2 Name], while survival rates are encouraging, what long-term considerations and potential late effects should clinicians and patients be aware of after treatment? How can we best address these issues to ensure optimal quality of life for survivors?**
**Conclusion:**
* **Thank you both for sharing your invaluable expertise and insights on this important topic. Any final thoughts for our viewers about the future of germ cell tumour management?**
**We hope this interview has provided a comprehensive overview of the current best practices in managing germ cell tumours of the testis. Remember to consult with your healthcare provider for personalized medical advice.**
