Testicular Cancer

ASCT for testicular cancer – pro

Testicular cancer usually responds well to front line chemohthrapy. Salvage therapy has been shown to induce long-term complete responses in about 25% of patients with disease that has persisted or recurred following other cisplatin-based regimens. Patients who have had an initial complete response to first-line chemotherapy and those without extensive disease have the most favorable outcome. However, the literature states that few, if any, patients

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Pediatric testicular cancer – pro

Malignant germ cell tumors (MGCT) account for 3% to 4% of childhood malignancies (< 15 years of age). Before the advent of multimodal therapy, children with MGCT could expect poor outcomes. Subsequent therapy was based on the larger adult experience with epithelial ovarian cancer because there was a paucity of clinical trials in pediatric patients. Cyclophosphamide-based therapy improved the outcome for patients with localized MGC but for patients

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PET for testicular cancer – pro

Lay Summary: PET is not recommended by NCCN for non-seminomatous testicular carcinoma. Most of the research on PET in testicular cancer focused on restaging, because functional assessment of residual masses after chemotherapy is of great clinical interest. Staging is less well studied. In a 2003, CMS reviewed 11 studies of FDG-PET in testicular cancer and concluded that the literature suggests a possible role for FDG PET in staging testicular cancer,

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Adjuvant treatment for stage I seminoma – pro

Options for stage I seminoma testicular cancer include surveillance, radiotherapy or carboplatin. Clinical stage I (CS I) seminoma has been the subject of various studies aimed at finding the ideal treatment. Due to its high radiosensitivity, radiotherapy has been the standard approach for decades. However, the fact that CS I seminoma has a recurrence rate of only 15-20% has prompted many suggestions for better treatment stratification offering surveillance

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Tandem and Triple Transplants for Testicular Cancer – pro

High dose chemotherapy with autologous stem cell rescue is an accepted and standard of care approach for relapsed or nonresponding testicular cancer. It is recommended by several guidelines, including NCCN. however, they do not explicitly address single versus tandem transplants. A tandem transplant is on that has a pre-planned second transplant with another infusion of stem cells after competion and recovery from the first transpalnt procedure.There

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Salvage for Testicular Cancer After Failure of Transplant – pro

The great majority of testicular cancer is cured with chemotherapy and the remaining cases have a high cure rate with transplant. The BEP regimen was proven to have less toxicity and a higher cure rate and therefore, since 1984, has been standard chemotherapy. This case failed on transplant and the question is about salvage therapy. Patients who are not cured with their initial BEP chemotherapy are usually treated with salvage chemotherapy. Approximately

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Extragonadal Germ Cell Tumors: Role of Transplant – pro

High dose chemotherapy with autologous stem cell rescue is an accepted and standard of care approach for relapsed or nonresponding testicular cancer. It is recommended by several guidelines, including NCCN. Extragonadal germinal cell syndromes are rare tumors that predominantly affect young males. Histologically, they mirror their gonadal counterparts with which they share the same chemosensitivity and radiosensitivity. Controversy remains regarding

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CT Followup for Testicular Cancer – pro

There is a difference of opinion between European and American guidelines regarding routine CT scanning for surveillance. ESMO recommends clinical review, chest X-ray and tumor markers monthly for 2 year, 2 monthly for the 2nd year, then 6monthly to 5 years and then annually and CT scans only as clinically indicated. Similar recommendation was made in the Netherlands. On the other hand, in the USA the NCCN (p.15)recommends abdomino- pelvic CT every

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Stage I Nonseminomatous Testicular Cancer – pro

Stage I nonseminoma germ cell cancers are highly curable (98%. As with seminomas, the initial treatment is radical inguinal orchiectomy. Then there are 3 options per guidelines: 1.Retroperitoneal lymph node dissection (RPLND) - mostly for stage IA. This has the advantage of a high cure rate and the disadvantages of major surgery with its complications and the possibility of the loss of ejaculation. 2.Careful observation with frequent (usually monthly)

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