Testicular choriocarcinoma is rare. In a literature review of 10,000 cases of germinal testicular cell tumors, Ramon y Cajal found 54 (0.5%) cases of pure choriocarcinoma. The tumors occurred mostly in men aged 20-30 years. Unlike classic seminoma or mixed GCTs, pure choriocarcinoma is more likely to present with symptoms from metastatic disease and is the most common element observed in brain metastases.
Pure choriocarcinoma, an extremely rare variant comprising less than 1% of NSGCT, is not as sensitive to chemotherapy as mixed NSGCT. A search of major textbooks and the literature revealed no clear guidelines as to how to treat these patients. Most case reports describe patients presenting with advanced metastatic disease, with varying responses to chemotherapy. In general, standard chemotherapy for poor-risk NSGCT is the initial therapy used in practice. However, these patients may require salvage regimens and may benefit from referral to a major cancer center to be treated under protocols that can involve cyclical regimens or dose escalation with growth factor/stem cell support. Standard chemotherapy for good-to-poor–risk NSGCT – Bleomycin, etoposide, cisplatin (BEP) for 4 cycles and salvage uses – Vinblastine, ifosfamide. A review in the past month stated: “Potentially curative options in the salvage setting include ifosfamide plus cisplatin-containing standard dose therapy and high-dose carboplatin plus stem-cell rescue. ”
Mead GM: Chemotherapeutic Management of Metastatic Germ Cell Testis Cancer. Risk-Adapted Therapy/Poor Risk Patients. In: Vogelzang et al, eds. Comprehensive Textbook of Genitourinary Oncology. 2nd ed. Philadelphia, Pa: Lippincott Williams & Williams; 2000: 1024-1031.
G. Sonpavde, T. E. Hutson, and B. J. Roth Management of Recurrent Testicular Germ Cell Tumors Oncologist, January 1, 2007; 12(1): 51 – 61.