Treatment of Seminoma Germ Cell Tumour at Clinical Stage I — Tumour Confined to the Testis

This protocol covers seminoma germ cell tumour (CS I SGCT) in the specific setting where disease is limited to the testis, with no regional lymph node metastasis and no distant metastasis.

Clinical Scenario

Seminoma Clinical Stage I Tumour limited to testis

Patients with CS I seminoma present with a germ cell tumour confined entirely to the testis — no regional nodal spread, no distant metastasis. This population carries a generally low risk of recurrence, and management decisions centre on whether to pursue active surveillance or adjuvant intervention, balancing residual relapse risk against long-term treatment effects.

Treatment Approach

When adjuvant treatment is chosen, a short course of systemic chemotherapy is the principal option. Adjuvant radiotherapy to regional fields may be offered in a highly selected subgroup — specifically patients unsuitable for systemic chemotherapy. The full selection criteria, regimen details, and decision algorithm are available in the complete structured protocol.

Clinical Goals

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

Instant Access to Structured Evidence-Based Regimens

References

Management options for CS I SGCTs include surveillance and adjuvant chemotherapy.
Patients with CS I SGCT have, in general, a low risk of recurrence.
Offer one dose of carboplatin at area under curve 7 if adjuvant chemotherapy is considered.
Adjuvant chemotherapy with one course carboplatin AUC 7 is not inferior to adjuvant radiotherapy when pathological risk factors are considered.
Radiotherapy to the ipsilateral retroperitoneal and common iliac field with a cumulative dose of 20Gy should be reserved for a highly selected group of patients, who are unsuitable for systemic chemotherapy in general, including adjuvant carboplatin or cisplatin-based combinations for relapsed disease.
Measure serum tumour markers both before and after orchidectomy taking into account half-life kinetics.

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