eUpdate – Testicular Seminoma and Non-Seminoma Treatment Recommendations

eUpdate – Testicular Seminoma and Non-Seminoma Treatment Recommendations

Published: 29 June 2017. Authors: Oldenburg J and Horwich A, on behalf of the ESMO Guidelines Committee

Clinical Practice Guidelines

This update refers to the Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Oldenburg J, Fosså SD, Nuver J et al, Ann Oncol 2016; 24 (Suppl 6): vi125–vi132.

Section

Post-orchiectomy staging and risk assessment

Text update

A new third paragraph is added: In summary, stage I tumours appear to be confined to the testis (although those in stage I with rising post-orchidectomy markers are accepted to have subclinical metastatic disease). Stage II tumours have abdominal node metastases IIA < 2 cm diameter, IIB 2–5 cm and IIC > 5 cm) and stage III tumours have more widespread metastases. Serum tumour marker (S) levels for prognostication of metastatic non-seminomas are classified into three groups, as follows:

  • All the markers must be in the stated range to be considered S1;
  • Only one marker needs to be in the stated range to be considered S2 or S3.

Section

Tables 1–5.

Text update

This eUpdate provides a new Table 1 and a new Table 2 to replace the original Table 1. ‘Post-orchiectomy staging of metastatic seminoma and non-seminoma according to AJCC/UICC and IGCCCG classification.’ Original Tables 2–4 are now Tables 3–5.

Serum tumour markers for non-seminoma testicular cancer

--- LDH (U/L) HCG (IU/L) AFP (ng/mL)
SX Marker studies not available or not carried out Marker studies not available or not carried out Marker studies not available or not carried out
S0 Normal Normal Normal
S1 < 1.5x ULN < 5000 < 1000
S2 1.5–10x ULN 5000–50 000 1000–10 000
S3 > 10x ULN > 50 000 > 10 000

AFP, alpha-fetoprotein; hCG, human chorionic gonadotropin; LDH, lactate dehydrogenase; ULN, upper limit of normal.

The IGCCCG Prognostic Classification for metastatic germ cell cancers

Good-prognosis group

Non-seminoma (56% of cases) All of the following criteria:
5-year PFS 89%
5-year survival 92%
  • Testicular/retroperitoneal primary
  • No non-pulmonary visceral metastases
  • AFP < 1000 ng/mL
  • hCG < 5000 IU/L (1000 ng/mL)
  • LDH < 1.5x ULN
Seminoma (90% of cases) All of the following criteria:
5-year PFS 82%
5-year survival 86%
  • Any primary site
  • No non-pulmonary visceral metastases
  • Normal AFP
  • Any hCG
  • Any LDH

Intermediate prognosis group

Non-seminoma (28% of cases) ---
5-year PFS 75%
  • Testicular/retroperitoneal primary
  • No non-pulmonary visceral metastases
5-year survival 80% And any of the following criteria:
hCG 5000–50 000 IU/L or
LDH 1.5–10x ULN
Seminoma (10% of cases) All of the following criteria:
5-year PFS 67%
5-year survival 72%
  • Any primary site
  • No non-pulmonary visceral metastases
  • Normal AFP
  • Any hCG
  • Any LDH

Poor prognosis group

Non-seminoma (16% of cases) Any of the following criteria:
5-year PFS 41%
5-year survival 48%
  • Mediastinal primary
  • Non-pulmonary visceral metastases
  • AFP > 10 000 ng/mL or
  • hCG > 50 000 IU/L (10 000 ng/mL) or
  • LDH > 10x ULN
Seminoma No patients classified as poor prognosis

Pre-chemotherapy serum tumour markers should be assessed after orchiectomy and immediately prior to the administration of chemotherapy (same day).

AFP, alpha-fetoprotein; hCG, human chorionic gonadotropin; IGCCCG, International Germ Cell Cancer Collaborative Group; LDH, lactate dehydrogenase; PFS, progression-free survival; ULN, upper limit of normal.