This protocol applies to patients with clinical stage IIA non-seminomatous germ cell tumour (NSGCT) — retroperitoneal lymph node metastasis up to 2 cm, with normal or normalised serum tumour markers — in whom first-line chemotherapy did not achieve the required response.
Non-seminomatous germ cell tumour, clinical stage IIA (retroperitoneal lymph node metastasis up to 2 cm), with normal or normalised serum tumour markers. In this setting, nerve-sparing retroperitoneal lymph node dissection performed by an experienced surgeon at a specialised centre is the recommended initial treatment approach.
The standard first-line step is adjuvant chemotherapy with BEP (cisplatin, etoposide, bleomycin) or EP (etoposide, cisplatin) for a maximum of two cycles. This protocol is triggered when those treatments do not reach their intended goals: normalisation of serum tumour markers (AFP, hCG, LDH) and no evidence of relapse on cross-sectional imaging. Failure to meet those targets calls for a further line of treatment.
Salvage cisplatin-based combination chemotherapy — using multi-agent regimens — is the strategy for patients who relapse or fail to respond after first-line treatment. The full selection of regimen options, their sequencing, and the criteria for choosing between them are detailed in the structured protocol.
The targets for this salvage line are normalisation of serum tumour markers and achievement of a complete or partial radiological response.
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.
The regimens of choice are four cycles of a three-agent regimen including cisplatin and ifosfamide plus a third drug: etoposide (VIP), paclitaxel (TIP), or potentially gemcitabine (GIP).
Cisplatin combination salvage chemotherapy will result in long-term remissions in approximately 50% of patients who relapse after first-line chemotherapy.
View source ↗