This protocol covers patients with non-seminomatous germ cell tumour at clinical stage IIA — characterised by retroperitoneal lymph node metastasis up to 2 cm — where serum tumour markers are normal or have normalised. This specific combination of limited nodal involvement and non-elevated markers defines the indication for the first-line approach described here.
Non-seminomatous germ cell tumour (NSGCT), clinical stage IIA (retroperitoneal lymph node metastasis up to 2 cm), with normal or normalised serum tumour markers. Accurate staging and marker status are central to selecting this pathway.
The recommended first-line intervention is a specialised surgical procedure targeting the retroperitoneal lymph nodes, undertaken by an experienced surgeon at a dedicated centre. The full structured regimen — including all decision points, management steps, and follow-up considerations — is available in the complete protocol.
With CS IIA NSGCT disease and normal or normalised tumour markers, nerve-sparing RPLND performed by an experienced surgeon in a specialised centre is the recommended initial treatment.
Nerve-sparing retroperitoneal lymph node dissection when performed by an experienced surgeon in a specialised centre is the recommended initial treatment in clinical stage (CS) IIA NSGCT disease without elevated tumour markers.
Patients may be downstaged to PS I in up to 20% of cases and require no further treatment.
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