Treatment of Testicular Cancer: Non-Seminomatous Germ Cell Tumour, Clinical Stage I (pT1) Without Lymphovascular Invasion

This protocol covers the management of clinical stage I non-seminomatous germ cell tumour (NSGCT) in patients staged pT1 with no lymphovascular invasion — a well-defined low-risk presentation with specific treatment considerations.

Clinical Scenario

The patient has non-seminomatous germ cell tumour confined to the testis (clinical stage I, pT1) with no lymphovascular invasion (LVI). Absence of LVI is a critical prognostic indicator: vascular invasion of the primary tumour is strongly associated with the risk of relapse, and its absence places this presentation in the low-risk category (Stage IA).

Approach

For low-risk CS I NSGCT, adjuvant chemotherapy is one of the management options considered for patients who are not undertaking surveillance. The complete regimen, patient selection criteria, and sequencing are detailed in the full structured protocol.

Treatment Goals

Normalisation of serum tumour markers: AFP, hCG, and LDH
No evidence of relapse on cross-sectional imaging

Instant Access to Structured Evidence-Based Regimens

References

For CS I NSGCT, invasion of the primary tumour into blood or lymphatic vessels, i.e. LVI, has long been described to be strongly associated with the risk of relapse.
Stage IA (pT1, no vascular invasion): low risk.
Offer adjuvant chemotherapy with one course of cisplatin, etoposide, bleomycin (BEP) in low-risk patients not willing (or unsuitable) to undergo surveillance.
One cycle of adjuvant BEP results in similar very low recurrence rates (2–3%).

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