Treatment of Seminoma Stage IIB–III with IGCCCG Intermediate Prognosis and Non-Pulmonary Visceral Metastases
Clinical Scenario
This protocol covers patients with seminoma at stage IIB–III who are classified as IGCCCG intermediate prognosis. The defining characteristic of this subgroup is the presence of non-pulmonary visceral metastases (e.g. hepatic, osseous, or central nervous system involvement) alongside a normal serum AFP. Serum hCG and LDH may be at any level. Patients must be fit for cisplatin-based chemotherapy.
Treatment Approach
Cisplatin-based combination chemotherapy with prophylactic growth factor support is the standard approach in the intermediate-prognosis setting. The choice of regimen depends on individual patient factors. The complete protocol — including regimen selection, cycle number, and criteria for choosing among available options — is available via the link below.
Treatment Goals
The primary aim is complete response after chemotherapy, defined as no residual disease on imaging and normalisation of serum tumour markers. Patients achieving a complete response do not require further treatment and proceed to surveillance follow-up.
References
DOI: 10.1016/j.annonc.2022.01.002
- 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.
- In order to reduce intercycle treatment delay and to avoid dose reduction due to neutropaenia, prophylactic G-CSF should be considered to maintain the dose intensity in patients with intermediate and poor prognosis and in particular when using the VIP regimen.
- Patients with complete response after ChT do not require further treatment and are candidates for follow-up.
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