Chemotherapy for testicular cancer

Abstract

The management of testicular cancer has evolved over the last three decades. The importance of staging and prognostic group assessments at all points in disease management has allowed reduction in treatment exposure for patients with good outcomes including the increased use of surveillance for stage 1 disease. Combination cisplatin and etoposide- based therapy remains the cornerstone of management of metastatic disease. The likelihood of success can be predicted for an individual based on tumor marker levels and sites of metastases. Patients with very advanced disease at presentation remain a challenge as chemotherapy often needs to be modified. The quality of response to this initial therapy itself predicts for success with further therapy should relapse occur. High dose chemotherapy with autologous stem cell support is of value in chemo-sensitive second relapse although its use earlier in the disease remains controversial. Surgery to sites of metastatic disease remains an important component of curative therapy. Finally attention to long term side effects has become of increasing importance and has led to increased efforts to reduce unnecessary treatment.