-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
-
Cosmetic Ingredient
- Water Treatment Chemical
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
Based on current research data and expert panel opinion, ESMO guidelines have developed recommendations for the diagnosis, staging, and treatment of testicular seminoma and non-seminoma
.
This article organizes the relevant suggestions of the expert group for readers! Diagnosis, Pathology, and Molecular Biology The diagnosis of germ cell tumor (GCT) should be based on histology [II, A] unless urgent cisplatin-containing chemotherapy (ChT) is indicated
.
Symptomatic patients with high tumor burden and elevated tumor markers should receive ChT immediately, even if clinical imaging is clear, to avoid delays in biopsy attempts [III, A]
.
Serum tumor markers (AFP, β-hCG, and LDH) should be monitored before and after orchiectomy and throughout follow-up for accurate staging and risk stratification to guide treatment and monitor recurrence [II, A]
.
Germ cell tumor in situ (GCNIS) is present in the contralateral testis in ~5% of GCT patients, requiring physical examination and/or ultrasonography during follow-up [III, A]
.
Because radiotherapy (RT) to GCNIS can affect fertility, early or delayed RT should be carefully discussed with the patient [III, A]
.
Staging and risk stratification should be managed by clinically experienced clinicians after orchiectomy [III, A]
.
All patients must have contrast-enhanced CT scans of the chest, abdomen, and pelvis [III, A]
.
Central nervous system (CNS) MRI is indicated for patients with poor prognosis, especially in patients with choriocarcinoma/high β-hCG, multiple lung metastases, or cerebral symptoms [III, A]
.
Conventional positron emission tomography (PET) [V, D] is not recommended
.
The International Germ Cell Cancer Collaborative Group (IGCCCG) is recommended for risk stratification of metastatic patients [III, A]
.
Treatment of local disease Treatment of the primary tumor is best preceded by orchiectomy, with semen analysis and sperm cryopreservation for all patients [II, B]
.
Semen preservation is the most cost-effective strategy for fertility preservation [II, A]
.
Radical orchiectomy should be performed through an inguinal incision [III, A]
.
Orchis-sparing surgery is feasible in selected patients in an experienced clinical center [III, A]
.
Orchiectomy or post-orchiectomy radiotherapy must be completed if GCT is diagnosed during orchi-sparing surgery because the risk of GCNIS in the other testis is high [III, A]
.
Patients with stage I seminoma should be informed of treatment options after orchiectomy: monitoring or adjuvant carboplatin; and treatment-specific recurrence rates, acute and long-term adverse events [II, A]
.
The effect of risk factors on micrometastases and the rationale for adjuvant carboplatin therapy for larger tumors and/or reticulotesticular invasion should be explained [III, B]
.
Patients without risk factors should not be given adjuvant carboplatin therapy [III, D]
.
After being fully informed of the advantages and disadvantages of surveillance, the patient's choice of post-orchiectomy treatment rather than direct administration of a single cycle of carboplatin should be considered [III, B]
.
RT should not be used as an adjuvant therapy option after orchiectomy [II, D]
.
Stage IIA seminoma should be at least histologically/cytologically verified for metastasis or to reduce overtreatment, with regular observation for radiological progression [III, B]
.
Patients should be encouraged to participate in ongoing clinical trials [III, B]
.
According to IGCCCG recommendations, stage IIA seminoma should be given radiotherapy (30 Gy/2 fractions) or cisplatin-containing chemotherapy (3 cycles of BEP [bleomycin + etoposide + cisplatin] or 4 cycles of EP) [etoposide + cisplatin]) [II, A]
.
Patients with stage I nonseminomas should be informed of their treatment options after orchiectomy: active surveillance or adjuvant chemotherapy; as well as treatment-specific recurrence rates, acute and long-term adverse events [II, A]
.
After being fully informed of the advantages and disadvantages of active surveillance, the patient's choice of post-orchiectomy treatment rather than direct administration of a single cycle of carboplatin should be considered [III, B]
.
Retroperitoneal lymph node dissection (RPLND) is not recommended [II, D]
.
In stage IIA nonseminoma, negative serum markers suggest careful evaluation to avoid overtreatment, because approximately 15% to 35% of patients with clinical stage IIA do not have disease metastases [II, A]
.
Stage IIA-IIB nonseminoma, positive serum markers should be treated according to IGCCCG recommendations for patients with serum marker positive stage IIA-IIB nonseminoma
.
For example, if bleomycin is contraindicated in low-risk patients, 3 cycles of BEP or 4 cycles of EP can be used [II, A]
.
Treatment of metastatic disease Stage II-III seminoma should be grouped according to IGCCCG, IIB-IIC, and stage III seminoma should be given cisplatin-containing chemotherapy [II, A]
.
Patients with stage IIB seminoma who are not candidates for chemotherapy should undergo para-aortic and ipsilateral iliac RT (36 Gy/2 fractions) [II, A]
.
Treatment of post-ChT seminoma patients with complete remission after ChT do not require further treatment [II, A]
.
For patients with residual tumor >3 cm, an FDG-PET scan is recommended at least six weeks after completion of ChT [III, B]
.
Stage IIA metastatic nonseminoma, marker-positive and stage IIB-III metastatic nonseminoma If the patient has a contraindication to bleomycin, IGCCCG patients with a good prognosis should receive 3 cycles of BEP or 4 cycles EP[II,A]
.
Patients with high-risk nonseminoma should be assessed for decreased AFP and β-hCG levels after the first cycle of BEP for intensive treatment in an experienced center [II, A]
.
Patients with nonseminomatous tumors with CNS metastases or primary mediastinal tumors should always be treated in experienced centers [II, A]
.
Prevention of Thromboembolic Events (TEE) Due to the need for continuous chemotherapy, TEE prophylaxis should be considered in patients with metastatic GCT, especially when one or more of the recognized risk factors are present: retroperitoneal lymph nodes >3.
5 cm, stage III disease, central venous Access catheters, intermediate or high risk features [III, B]
.
A peripheral venous access catheter should be used instead of an indwelling vascular access device (VAD) [III, A]
.
Treatment of non-seminomas after chemotherapy Remnant lymph nodes >1 cm in axial diameter should be resected preferentially by open surgery with nerve-sparing RPLND [II, A]
.
Patients with multiple visceral metastases should always be evaluated by experienced specialists [II, A]
.
Second-line routine-dose ChT (eg, TIP [cisplatin + ifosfamide + paclitaxel]) in a specialized hospital is recommended for salvage therapy [II, A]
.
High-dose ChT in the third line and above may be curable in screened patients [II, A]
.
Surgery is an important part of salvage treatment strategies [III, A]
.
Treatment of patients with late recurrence 2% to 3% of patients with late recurrence should be treated only in specialist centers [II, A]
.
ChT should be administered based on histology and tumor markers in patients with advanced recurrence [II, A]
.
Surgery should be an integral part of curative treatment [II, A]
.
Serum miRNAs for personalized therapy show potential clinical applicability, but are currently not recommended for routine clinical practice [III, D]
.
Follow-up, Long-Term Efficacy, and Survival Due to the long-term risks of hypogonadism, GCT survivors should undergo periodic hormonal assessment [II, A]
.
Testosterone replacement therapy is reserved for testicular cancer survivors, patients with testosterone levels below the normal range and symptoms of hypogonadism [III, B]
.
Encourage a healthy life>
.
References Oldenburg J, Berney DM, Bokemeyer C, et al.
Testicular seminoma and non-seminoma: ESMO-EURACAN Clinical Practice Guideline for diagnosis, treatment and follow-up† , Annals of Oncology (2022), doi: https:// doi.
org/10.
1016/j.
annonc.
2022.
01.
002
.
This article organizes the relevant suggestions of the expert group for readers! Diagnosis, Pathology, and Molecular Biology The diagnosis of germ cell tumor (GCT) should be based on histology [II, A] unless urgent cisplatin-containing chemotherapy (ChT) is indicated
.
Symptomatic patients with high tumor burden and elevated tumor markers should receive ChT immediately, even if clinical imaging is clear, to avoid delays in biopsy attempts [III, A]
.
Serum tumor markers (AFP, β-hCG, and LDH) should be monitored before and after orchiectomy and throughout follow-up for accurate staging and risk stratification to guide treatment and monitor recurrence [II, A]
.
Germ cell tumor in situ (GCNIS) is present in the contralateral testis in ~5% of GCT patients, requiring physical examination and/or ultrasonography during follow-up [III, A]
.
Because radiotherapy (RT) to GCNIS can affect fertility, early or delayed RT should be carefully discussed with the patient [III, A]
.
Staging and risk stratification should be managed by clinically experienced clinicians after orchiectomy [III, A]
.
All patients must have contrast-enhanced CT scans of the chest, abdomen, and pelvis [III, A]
.
Central nervous system (CNS) MRI is indicated for patients with poor prognosis, especially in patients with choriocarcinoma/high β-hCG, multiple lung metastases, or cerebral symptoms [III, A]
.
Conventional positron emission tomography (PET) [V, D] is not recommended
.
The International Germ Cell Cancer Collaborative Group (IGCCCG) is recommended for risk stratification of metastatic patients [III, A]
.
Treatment of local disease Treatment of the primary tumor is best preceded by orchiectomy, with semen analysis and sperm cryopreservation for all patients [II, B]
.
Semen preservation is the most cost-effective strategy for fertility preservation [II, A]
.
Radical orchiectomy should be performed through an inguinal incision [III, A]
.
Orchis-sparing surgery is feasible in selected patients in an experienced clinical center [III, A]
.
Orchiectomy or post-orchiectomy radiotherapy must be completed if GCT is diagnosed during orchi-sparing surgery because the risk of GCNIS in the other testis is high [III, A]
.
Patients with stage I seminoma should be informed of treatment options after orchiectomy: monitoring or adjuvant carboplatin; and treatment-specific recurrence rates, acute and long-term adverse events [II, A]
.
The effect of risk factors on micrometastases and the rationale for adjuvant carboplatin therapy for larger tumors and/or reticulotesticular invasion should be explained [III, B]
.
Patients without risk factors should not be given adjuvant carboplatin therapy [III, D]
.
After being fully informed of the advantages and disadvantages of surveillance, the patient's choice of post-orchiectomy treatment rather than direct administration of a single cycle of carboplatin should be considered [III, B]
.
RT should not be used as an adjuvant therapy option after orchiectomy [II, D]
.
Stage IIA seminoma should be at least histologically/cytologically verified for metastasis or to reduce overtreatment, with regular observation for radiological progression [III, B]
.
Patients should be encouraged to participate in ongoing clinical trials [III, B]
.
According to IGCCCG recommendations, stage IIA seminoma should be given radiotherapy (30 Gy/2 fractions) or cisplatin-containing chemotherapy (3 cycles of BEP [bleomycin + etoposide + cisplatin] or 4 cycles of EP) [etoposide + cisplatin]) [II, A]
.
Patients with stage I nonseminomas should be informed of their treatment options after orchiectomy: active surveillance or adjuvant chemotherapy; as well as treatment-specific recurrence rates, acute and long-term adverse events [II, A]
.
After being fully informed of the advantages and disadvantages of active surveillance, the patient's choice of post-orchiectomy treatment rather than direct administration of a single cycle of carboplatin should be considered [III, B]
.
Retroperitoneal lymph node dissection (RPLND) is not recommended [II, D]
.
In stage IIA nonseminoma, negative serum markers suggest careful evaluation to avoid overtreatment, because approximately 15% to 35% of patients with clinical stage IIA do not have disease metastases [II, A]
.
Stage IIA-IIB nonseminoma, positive serum markers should be treated according to IGCCCG recommendations for patients with serum marker positive stage IIA-IIB nonseminoma
.
For example, if bleomycin is contraindicated in low-risk patients, 3 cycles of BEP or 4 cycles of EP can be used [II, A]
.
Treatment of metastatic disease Stage II-III seminoma should be grouped according to IGCCCG, IIB-IIC, and stage III seminoma should be given cisplatin-containing chemotherapy [II, A]
.
Patients with stage IIB seminoma who are not candidates for chemotherapy should undergo para-aortic and ipsilateral iliac RT (36 Gy/2 fractions) [II, A]
.
Treatment of post-ChT seminoma patients with complete remission after ChT do not require further treatment [II, A]
.
For patients with residual tumor >3 cm, an FDG-PET scan is recommended at least six weeks after completion of ChT [III, B]
.
Stage IIA metastatic nonseminoma, marker-positive and stage IIB-III metastatic nonseminoma If the patient has a contraindication to bleomycin, IGCCCG patients with a good prognosis should receive 3 cycles of BEP or 4 cycles EP[II,A]
.
Patients with high-risk nonseminoma should be assessed for decreased AFP and β-hCG levels after the first cycle of BEP for intensive treatment in an experienced center [II, A]
.
Patients with nonseminomatous tumors with CNS metastases or primary mediastinal tumors should always be treated in experienced centers [II, A]
.
Prevention of Thromboembolic Events (TEE) Due to the need for continuous chemotherapy, TEE prophylaxis should be considered in patients with metastatic GCT, especially when one or more of the recognized risk factors are present: retroperitoneal lymph nodes >3.
5 cm, stage III disease, central venous Access catheters, intermediate or high risk features [III, B]
.
A peripheral venous access catheter should be used instead of an indwelling vascular access device (VAD) [III, A]
.
Treatment of non-seminomas after chemotherapy Remnant lymph nodes >1 cm in axial diameter should be resected preferentially by open surgery with nerve-sparing RPLND [II, A]
.
Patients with multiple visceral metastases should always be evaluated by experienced specialists [II, A]
.
Second-line routine-dose ChT (eg, TIP [cisplatin + ifosfamide + paclitaxel]) in a specialized hospital is recommended for salvage therapy [II, A]
.
High-dose ChT in the third line and above may be curable in screened patients [II, A]
.
Surgery is an important part of salvage treatment strategies [III, A]
.
Treatment of patients with late recurrence 2% to 3% of patients with late recurrence should be treated only in specialist centers [II, A]
.
ChT should be administered based on histology and tumor markers in patients with advanced recurrence [II, A]
.
Surgery should be an integral part of curative treatment [II, A]
.
Serum miRNAs for personalized therapy show potential clinical applicability, but are currently not recommended for routine clinical practice [III, D]
.
Follow-up, Long-Term Efficacy, and Survival Due to the long-term risks of hypogonadism, GCT survivors should undergo periodic hormonal assessment [II, A]
.
Testosterone replacement therapy is reserved for testicular cancer survivors, patients with testosterone levels below the normal range and symptoms of hypogonadism [III, B]
.
Encourage a healthy life>
.
References Oldenburg J, Berney DM, Bokemeyer C, et al.
Testicular seminoma and non-seminoma: ESMO-EURACAN Clinical Practice Guideline for diagnosis, treatment and follow-up† , Annals of Oncology (2022), doi: https:// doi.
org/10.
1016/j.
annonc.
2022.
01.
002
