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% |
|
Seminoma (90% of cases) |
All of the following criteria: |
5-year PFS 82% |
|
Intermediate prognosis group
Non-seminoma (28% of cases) |
--- |
---|---|
5-year PFS 75% |
|
5-year survival 80% |
And any of the following criteria: |
Seminoma (10% of cases) |
All of the following criteria: |
5-year PFS 67% |
|
Poor prognosis group
Non-seminoma (16% of cases) |
Any of the following criteria: |
---|---|
5-year PFS 41% |
|
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.