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SYMPOSIUM
Year : 2010  |  Volume : 26  |  Issue : 1  |  Page : 108-114

Management of poor-prognosis testicular germ cell tumors


Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Solid Tumor Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA

Correspondence Address:
Andrew J Stephenson
Section of Urologic Oncology, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk Q10-1, Cleveland, OH 44195-0001
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-1591.61228

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Currently, the outcome of patients with intermediate- and poor-risk germ cell tumors at diagnosis is optimized by the use of risk-appropriate chemotherapy and post-chemotherapy surgical resection of residual masses. Currently, there is no role for high-dose chemotherapy in the first-line setting. Patients who progress on first-line chemotherapy or who relapse after an initial complete response also have a poor prognosis. In the setting of early relapse, the standard approach at most centers is conventional-dose, ifosfamide-based regimens and post-chemotherapy resection of residual masses. The treatment of patients with late relapse is complete surgical resection whenever feasible. Salvage chemotherapy for late relapse may be used prior to surgery in patients where a complete resection is not feasible. A complete surgical resection of all residual sites of disease after chemotherapy is critical for the prevention of relapse and the long-term survival of patients with advanced germ cell tumors.


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