Intermediate-Prognosis Metastatic NSGCT: What to Do When BEP or VIP Leaves Residual Retroperitoneal Masses
This protocol addresses patients with non-seminomatous germ cell tumour (NSGCT) presenting as metastatic disease classified in the IGCCCG intermediate prognosis group — a testis or retroperitoneal primary site, no nonpulmonary visceral metastases, and intermediate-range tumour marker elevation — who have completed first-line chemotherapy but retain visible residual retroperitoneal masses.
- Testis or retroperitoneal primary site
- No nonpulmonary visceral metastases
- AFP 1,000–10,000 ng/mL, or hCG 5,000–50,000 IU/L, or LDH 1.5–10 × upper limit of normal
First-line chemotherapy — BEP (cisplatin, etoposide, bleomycin) for 4 cycles as standard, or VIP (etoposide, cisplatin, ifosfamide) when bleomycin is contraindicated — aims to normalise serum tumour markers (AFP, hCG, LDH) and achieve a complete or partial radiological response.
When chemotherapy leaves visible residual retroperitoneal masses greater than 1 cm, even with markers normalising, a further intervention is indicated and this protocol defines the next step.
The protocol involves a surgical approach targeting residual retroperitoneal masses that persist after chemotherapy, with the goal of complete resection of those residual masses.
References
Any of the following criteria: Testis/retro-peritoneal primary, No nonpulmonary visceral metastases. And any of the following criteria: AFP 1,000 - 10,000ng/mL or hCG 5,000 - 50,000 IU/L or LDH 1.5-10 x ULN.
Treat metastatic NSGCT (stage > IIC) with an intermediate prognosis with four cycles of standard BEP.
Perform surgical resection of visible (> 1cm in longest diameter) residual masses after chemotherapy for NSGCT when serum levels of tumour markers are normal or normalising.
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