Cancer specific survival for men with early stage (I to IIB) testicular
germ cell tumors is greater than 90% with any management strategy. The data regarding the comparative effectiveness of surveillance, primary
chemotherapy,
radiotherapy and retroperitoneal
lymph node dissection were synthesized with a focus on oncologic outcomes, patient reported outcomes, and short and long-term toxicities.
MATERIALS AND METHODS: RESULTS:
Cancer specific survival ranged from 94% to 100% for patients with early stage testicular
germ cell tumors regardless of
tumor histology and initial management strategy. For men with
seminoma the median
cancer specific survival was 99.7% (range 97% to 100%), 99.5% (96.8% to 100%) and 100% (100% to 100%) among those managed by surveillance,
radiotherapy and
chemotherapy, respectively. Median
cancer specific survival for men with nonseminomatous testicular
germ cell tumors was 100% (range 98.6% to 100%), 100% (96.9% to 100%) and 100% (94% to 100%) when managed by surveillance, retroperitoneal
lymph node dissection and
chemotherapy, respectively. Recurrence rates and toxicities varied by management strategy. For men with
seminoma surveillance,
chemotherapy and
radiotherapy were associated with median recurrence rates of 15%, 2% and 3.7%, respectively. For men with nonseminomatous testicular
germ cell tumors the median recurrence rates were 20.5%, 3.3% and 11.1% for surveillance,
chemotherapy and retroperitoneal
lymph node dissection, respectively. Surveillance was associated with minimal toxicities compared to other approaches. Primary
chemotherapy had the highest rate of short-term toxicities and was associated with long-term risks of
metabolic syndrome,
hypogonadism, renal impairment, neuropathy,
infertility and secondary
malignancies. Toxicities with
radiotherapy included acute
dermatitis and long-term gastrointestinal complications,
infertility and high rates of secondary
malignancies (2% to 3%). Patients undergoing retroperitoneal
lymph node dissection had significant risk of toxicity perioperatively and long-term
infertility in men with
anejaculation. Transient detriments in patient reported outcomes and quality of life were noted with all management options.
CONCLUSIONS: Men with early stage testicular
germ cell tumors experience excellent
cancer specific survival regardless of management strategy. Management options, however, differ in terms of associated recurrence rates, short and long-term toxicities, and patient reported outcomes. The profile for each approach should be clearly communicated to patients and matched with patient preferences to offer the best individual outcome.