Metastatic NSGCT (IGCCCG Good Prognosis): What to Do When Retroperitoneal Lymph Node Dissection Did Not Achieve Complete Resection

This protocol is for patients with metastatic non-seminomatous germ cell tumour (NSGCT) in the IGCCCG good prognosis group who have undergone prior surgical management of residual retroperitoneal disease and require escalation because that step did not achieve its intended goals.

Patient Population

All of the following must apply:

Testis or retroperitoneal primary
No nonpulmonary visceral metastases
AFP < 1,000 ng/mL
hCG < 5,000 IU/L
LDH < 1.5 × upper limit of normal

Why This Line Is Required

The preceding step—bilateral nerve-sparing retroperitoneal lymph node dissection (RPLND) for residual masses greater than 1 cm—aimed to achieve complete resection and histological classification of residual tissue (necrotic-fibrotic tissue, postpubertal teratoma, or active cancer). When complete resection is not accomplished, or the histological findings indicate the need for further treatment, escalation to systemic therapy is required.

Next-Line Approach

The next step involves salvage chemotherapy using a multi-agent, cisplatin-containing regimen administered in defined cycles. The complete protocol specifies which regimen combinations apply and under what conditions. Clinical targets include normalisation of serum tumour markers and a complete or partial radiological response.

Instant Access to Structured Evidence-Based Regimens

References

All of the following criteria: Testis/retroperitoneal primary, No nonpulmonary visceral metastases, AFP < 1,000 ng/mL, hCG < 5,000 IU/L (1,000 ng/mL), LDH < 1.5 × ULN.

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).

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