SEOM-GG clinical guidelines for the management of germ-cell testicular cancer (2023)

• Published in: Clinical & translational oncology 2024-11, Vol.26 (11), p.2783-2799
• Main Authors: Arranz Arija, José Angel, del Muro, Xavier García, Caro, Raquel Luque, Méndez-Vidal, María José, Pérez-Valderrama, Begoña, Aparicio, Jorge, Climent Durán, Miguel Ángel, Caballero Díaz, Cristina, Durán, Ignacio, González-Billalabeitia, Enrique
• Format: Article
• Language: English
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Clinical Guides in Oncology; Humans; Male; Medical Oncology - methods; Medical Oncology - standards; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local - therapy; Neoplasms, Germ Cell and Embryonal - pathology; Neoplasms, Germ Cell and Embryonal - therapy; Oncology; Orchiectomy; Practice Guidelines as Topic; Prognosis; Salvage Therapy; Societies, Medical; Testicular Neoplasms - pathology; Testicular Neoplasms - therapy
• ISSN: 1699-3055; 1699-048X; 1699-3055
• DOI: 10.1007/s12094-024-03532-2

Testicular germ cell tumors are the most common tumors in adolescent and young men. They are curable malignancies that should be treated with curative intent, minimizing acute and long-term side effects. Inguinal orchiectomy is the main diagnostic procedure, and is also curative for most localized tumors, while patients with unfavorable risk factors for recurrence, or those who are unable or unwilling to undergo close follow-up, may require adjuvant treatment. Patients with persistent markers after orchiectomy or advanced disease at diagnosis should be staged and classified according to the IGCCCG prognostic classification. BEP is the most recommended chemotherapy, but other schedules such as EP or VIP may be used to avoid bleomycin in some patients. Efforts should be made to avoid unnecessary delays and dose reductions wherever possible. Insufficient marker decline after each cycle is associated with poor prognosis. Management of residual masses after chemotherapy differs between patients with seminoma and non-seminoma tumors. Patients at high risk of relapse, those with refractory tumors, or those who relapse after chemotherapy should be managed by multidisciplinary teams in experienced centers. Salvage treatment for these patients includes conventional-dose chemotherapy (TIP) and/or high-dose chemotherapy, although the best regimen and strategy for each subgroup of patients is not yet well established. In late recurrences, early complete surgical resection should be performed when feasible. Given the high cure rate of TGCT, oncologists should work with patients to prevent and identify potential long-term side effects of the treatment. The above recommendations also apply to extragonadal retroperitoneal and mediastinal tumors.