Treatment of testicular tumours based on risk factors

Germ cell cancer is highly sensitive to cisplatinum-based chemotherapy, resulting in cure rates of over 90% for patients with minimal metastatic disease or low tumour markers, 70% for patients with intermediate prognosis features, and 50% for patients with poor prognosis criteria. Whereas current clinical studies aim to improve the survival of patients with poor prognosis by means of high-dose chemotherapy, or the survival of intermediate prognosis patients by more intensive chemotherapy, for patients with good prognosis the reduction of doses, number of drugs or cycles is investigated to reduce the short-term and, in particular, long-term treatment sequelae. However, apart from these clinical studies, the current treatment standard of three cycles of platinum/etoposide/bleomycin for good prognosis patients and four cycles for intermediate and poor prognosis patients with advanced germ cell cancer has not been changed by recent trial results. The excellent cure rate with cisplatinum-based chemotherapy in the case of early metastatic disease with three cycles of platinum/etoposide/bleomycin as well as the high efficacy of adjuvant chemotherapy with two cycles of platinum/etoposide/bleomycin in the case of microscopic disease did change the treatment standards in stage I and II non-seminomatous germ cell cancer, with defined treatment options depending on prognostic factors. The treatment of testicular cancer based on prognostic factors is mandatory in all stages of seminoma and non-seminoma; however, molecular biological factors might make a major contribution to a more precise determination of prognosis and therefore enable a tailored selection of an individual treatment in the future.