This protocol applies to patients with seminoma at stage IIB through III who are classified as IGCCCG good prognosis. The defining features of this population are the absence of non-pulmonary visceral metastases, normal serum alpha-fetoprotein (AFP), and fitness for cisplatin-based chemotherapy. Any hCG level is permissible within this classification.
Normal serum AFP is a required criterion for the IGCCCG good prognosis category in this setting. Patients must additionally have no non-pulmonary visceral metastases and must be clinically fit to receive cisplatin-based systemic therapy.
Cisplatin-based combination chemotherapy is the standard approach in this setting. The specific regimen and number of cycles are determined by individual patient eligibility for components of the regimen.
Complete response after chemotherapy, with no residual disease on imaging and normalisation of serum tumour markers.
Cisplatin-based ChT according to the IGCCCG classification is standard for seminoma stage IIB-IIC and III.
Three cycles of BEP represents the standard therapy for seminoma patients categorised as good prognosis and four cycles of BEP for intermediate prognosis.
If there are contraindications against bleomycin, e.g. reduction in lung capacity (diffusing capacity of lung for carbon monoxide score), emphysema or heavy smoking (including former smokers), four cycles of EP are recommended in good-prognosis patients and four cycles of etoposide, ifosfamide and cisplatin (VIP) in intermediate-prognosis patients.
Patients with complete response after ChT do not require further treatment and are candidates for follow-up.
View source ↗