Elsevier

European Urology

Volume 53, Issue 3, March 2008, Pages 478-496
European Urology

Review – Testis Cancer
European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus group (EGCCCG): Part I

https://doi.org/10.1016/j.eururo.2007.12.024Get rights and content

Abstract

Objectives

The first consensus report presented by the European Germ Cell Cancer Consensus Group (EGCCCG) in the year 2004 has found widespread approval by many colleagues throughout the world. In November 2006, the group met a second time under the auspices of the Department of Urology of the Amsterdam Medical Center, Amsterdam, The Netherlands.

Methods

Medical oncologists, urological surgeons, radiation oncologists as well as pathologists from several European countries reviewed and discussed the data that had emerged since the 2002 conference, and incorporated the new data into updated and revised guidelines. As for the first meeting, the methodology of evidence-based medicine (EBM) was applied. The results of the discussion were compiled by the writing committee. All participants have agreed to this final update.

Results

The first part of the consensus paper describes the clinical presentation of the primary tumor, its treatment, the importance and treatment of testicular intraepithelial neoplasia (TIN), histological classification, staging and prognostic factors, and treatment of stage I seminoma and non-seminoma.

Conclusions

Whereas the vast majority of the recommendations made in 2004 remain valid 3 yr later, refinements in the treatment of early- and advanced-stage testicular cancer have emerged from clinical trials. Despite technical improvements, expert clinical skills will continue to be one of the major determinants for the prognosis of patients with germ cell cancer. In addition, the particular needs of testicular cancer survivors have been acknowledged.

Section snippets

Diagnosis and staging

In 2004 the first consensus paper on diagnostics and treatment in testicular cancer was prepared by the European Germ Cell Cancer Consensus Group (EGCCCG) [1]. In this interdisciplinary process by medical oncologists, urologic surgeons, radiation oncologists and pathologists the methodology of evidence-based medicine (EBM) was applied (Table 1) [2], [3]. This paper is an update with the new data emerged since 2002 integrated and prepared again on the basis of evidence-based medicine.

Orchiectomy

As a rule orchiectomy is performed before any further treatment (Table 3). Orchiectomy should be scheduled timely (within 1 wk). However, there is no need for emergency (within 24 h) surgery. The results of the tumour marker determination should be available before surgery and have to be reevaluated thereafter to determine the half-life kinetic (half-life time: AFP < 7 d; ß-HCG < 3 d).

Radical orchiectomy is performed through an inguinal incision [26], [27], [28]. Any scrotal violation for biopsy or

Testicular biopsy in patients with gonadal germ cell cancer

Intratubular germ cell neoplasia (TIN/CIS) is defined as a malignant preinvasive testicular germ cell lesion. In patients with TIN, the cumulative probability for the development of a testicular tumour is 70% after 7 yr [EBM IIB: 36]. Up to 9% of patients with testicular tumours harbour TIN within the contralateral “normal” testicle, which is detectable by open biopsy, best performed as a double biopsy to increase the detection rate to >99% [37], [38] (Table 4). For patients with testicular

Histological examination of germ cell cancer

It is recommended to completely laminate the testicular specimen in transverse sections. Additional sections have to be taken from the spermatic cord. For full histological examination of the tumour, it is necessary to obtain one block per centimetre of tumour, not less than a total of three blocks, as well as blocks from the peritumoural region and of remote testicular tissue. Further samples have to be taken from the funicular resection margin and from the spermatic cord within a 1-cm

Treatment-associated fertility issues and sperm banking

In patients of reproductive age, baseline fertility assessment should be performed, including the determination of total testosterone level, luteinising hormone, follicle-stimulating hormone, and semen analysis. The patient must be informed about and offered the possibility of cryoconservation, preferably carried out before orchiectomy [47], [50], [104], [105], [106], [107], [108]. Patients with bilateral testicular tumours, or a testicular tumour with contralateral TIN and with severe oligo-,

Treatment of patients with seminoma CS I

Despite normal CT scans, up to 32% of patients with CS I seminoma can relapse if no adjuvant treatment is given [57], [115], [116]. Nevertheless, the cure rate in CS I seminoma patients is almost 100% and can be achieved with three strategies: surveillance with salvage irradiation or chemotherapy at relapse, adjuvant chemotherapy with single-agent carboplatin, and—with the most mature follow-up data—adjuvant radiation treatment [117], [118], [119], [120]. Tumour size >4 cm and rete testis

Treatment of patients with non-seminoma CS I

If treatment is performed correctly, the cure rate of patients with non-seminoma CS I should be 99%, regardless of the management chosen [67], [140]. In the case of surveillance, the relapse rate is 27–30% when considering a long-term follow up of ≤20 yr [71], [140]. Relapses occur in the retroperitoneum in 54–78% of patients, and in the lung in 13–31%, but are very rarely found in more than one visceral organ [140], [141], [142].

VI of the primary tumour is the most important prognostic

Conflicts of interest

The authors have nothing to disclose.

Acknowledgements

This consensus document was made possible by the input of the participants of the 2006 consensus conference who discussed and prepared this update of the 2002 consensus meeting.

All participants particularly like to thank Dr M. Pilar Laguna, Mrs Sonja van Rees Vellinga, and Karin Plass for organizing the meeting.

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