Testicular cancer medical therapy

The predominant therapy for testicular cancer is surgical resection. Adjunctive chemotherapy and radiation therapy may be required.

Seminoma:

Seminoma is sensitive to radiotherapy and chemotherapy.

Stage IA and IB^[1]

• Surveillance for pT1-T3 tumors or
• Single agent carboplatin for 1 or 2 cycles followed with chest x-ray and CT scan of the abdomen and pelvis. ^[2][3]
• Radiation therapy

Stage IS

• Recheck the serum marker and the chest X-ray and Ct scan of abdomen and pelvis.

Stage IIA

• Bleomycin, etoposide, and cisplatin for 3 cycles or etoposide, and cisplatin for 4 cycles.
• Low dose of radiation therapy is preferred over chemotherapy.

Stage IIB or IIC

• Bleomycin, etoposide, and cisplatin for 3 cycles or etoposide, and cisplatin for 4 cycles.
• Combined chemotherapy is recommended over radiation therapy.

• Radiation therapy works best for seminoma. Non-seminoma do not respond well to radiation therapy.
• External beam radiation may be used for stage I and most stage II seminomas after orchiectomy.^[4]
• Radiation therapy after orchiectomy including the para-aortic and ipsilateral iliac lymph nodes for stage IIA seminoma.^[5]
• Radiation therapy in selected non bulky (3 cm or < 3 cm) including the para-aortic and ipsilateral iliac lymph nodes for stage IIB seminoma.^[6][7]
• Radiation treatments are usually given once a day, 5 days a week, for 2–4 weeks.

Standard-dose chemotherapy^[8][9]

• The most common chemotherapy combinations used to treat testicular cancer are:

• Bleomycin, etoposide, and cisplatin

• It is usually given IV every 3 weeks for 3 months for 3 cycles for metastasis to brain, stage IIA, IIB, IIC, and good risk stage III seminoma as well as good risk stage IIA, IIB, and stage IIC, IIIA Nonseminoma.

• Etoposide and cisplatin are given for 4 cycles for metastasis to brain, stage IIA, IIB, IIC and good risk stage III seminoma as well as good risk stage IIA, IIB, and stage IIC, IIIA Nonseminoma.^[10]

• It is used when bleomycin affects the lungs or there is a high risk that it will cause lung damage.

• Bleomycin, etoposide, and cisplatin or etoposide, mesna, ifosfamide, and cisplatin are given for 4 cycles for intermediate risk stage III seminoma and intermediate and poor risk stage IIIC Nonseminoma.

• Bleomycin, etoposide, and cisplatin for 1 cycle for stage I nonseminoma with and without risk factors.^[11]

• If testicular cancer does not respond to the above drugs or if it recurs, the following chemotherapy combinations may be used. These are sometimes called salvage, or second-line, chemotherapy.

• Paclitaxel, ifosfamide and cisplatin

• It is given IV every 3 weeks for 3 months, or 4 cycles.

• Etoposide, ifosfamide and cisplatin

• It is given IV every 3 weeks for 3 months, or 4 cycles.

• Etoposide or vinblastine, ifosfamide and cisplatin

• It is given IV every 3 weeks for 3 months, or 4 cycles.

High-dose chemotherapy

• High-dose chemotherapy with carboplatin and etoposide may be used if testicular cancer recurs after it is treated with standard-dose chemotherapy.

Palliative chemotherapy

• Palliative therapy is given to relieve symptoms, rather than to treat the cancer itself. Gemcitabine may be given with oxaliplatin, paclitaxel or both as palliative treatment for seminomas or non-seminoma.

• Most sex cord stromal testicular tumors may not respond to chemotherapy and radiation.^[12][13]
• Adjuvants are not helpful nor effective.

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