Therapeutic target
- Healing
Therapy recommendations
Germ cell tumors/seminoma
- Seminoma is very sensitive to radiation. The risk of occult metastasis (daughter tumor formation not yet detectable despite regular staging) to the locoregional lymph nodes (in the immediate vicinity of the tumor) in stage I is approximately 20% (EBM IIB: 100, 127-129). Nevertheless, a cure rate of almost 100% is achieved. It can be achieved with two strategies:
- Adjuvant (complementary) radiotherapy with reduction of the risk of recurrence (risk of tumor recurrence) to 3 to 4% (EBM IB: 130,131; EBM II A: 132-134) or.
- Wait-and-see strategy (so-called wait-and-see strategy or surveillance strategy) with definitive therapy only in case of recurrence (radiotherapy or chemotherapy).
- Seminoma in non-metastatic clinical stage I (cSI): due torecurrence: all therapy options (surveillance, adjuvant chemotherapy with carboplatin, adjuvant radiotherapy) achieve the same survival rates, if in case of recurrence this is treated according to stage [guidelines: S3 guideline].
- Metastatic germ cell tumors of the testis [guidelines: S3 guideline].
- Stage cSIIA seminoma: either radiotherapy or chemotherapy with three cycles of cisplatin, etoposide, and bleomycin (PEB) (alternatively, four cycles of etoposide-platinum (EP) if contraindicated to bleomycin).
- Stage cSIIB seminoma: receive chemotherapy with three cycles of PEB or four cycles of EP if contraindicated to bleomycin. Alternatively, radiotherapy may be given.
- Stage IIC/III metastatic seminoma and good prognosis: three cycles of PEB chemotherapy; if contraindicated to bleomycin, four cycles of EP chemotherapy.
- Brain metastases at initial diagnosis: four cycles of chemotherapy (PEB, PEI) analogous to IGCCCG classification for poor prognosis patients.
- Bone metastases at initial diagnosis: four cycles of chemotherapy (PEB, PEI) analogous to IGCCCG classification for intermediate prognosis patients
- Following chemotherapy, subsequent local therapy of bone foci should be considered (resection or radiatio (radiation therapy), if technically feasible).
Non-seminomatous germ cell tumor/non-seminoma
- Non-seminoma, unlike seminoma, is highly chemotherapy-sensitive. There are two therapeutic strategies for nonseminoma:
- Retroperitoneal lymphadenectomy (removal of abdominal lymph nodes) (RLA) OR.
- Risk-adapted therapy with “surveillance” for low-risk patients and adjuvant chemotherapy for those at high risk
- Cure rate is 99% regardless of therapeutic approach.
- Confirmed nonseminomatous CCT in cSIIA/B: treat analogously to the IGCCCG prognosis group using chemotherapy (three to four cycles of PEB) and, in the presence of residual tumor (tumor portions remaining in the body after treatment), retroperitoneal residual tumor resection (RTR; surgical removal of residual tumor).
- Bone metastases at initial diagnosis: four cycles of chemotherapy (PEB, PEI) analogous to IGCCCG classification for poor prognosis
- Following chemotherapy, subsequent local therapy of bone foci should be considered (resection or radiation, if technically feasible).
- In cases of extensive metastasis, high-dose chemotherapy should precede orchiectomy (testicular removal).
- In case of recurrence (recurrence of the tumor): attempt to cure the tumor again primarily by surgical removal or else by renewed chemotherapy, usually followed by surgery.
- See also under “Further therapy”.
No detailed information on active ingredients and dosages is given here, because the therapy regimens are constantly modified.
