Treatment of Seminoma with Metastatic Disease — IGCCCG Intermediate Prognosis Group
This protocol covers patients with seminoma germ cell tumour who present with metastatic disease and are classified in the IGCCCG intermediate prognosis group. In seminoma, intermediate prognosis is defined by the presence of nonpulmonary visceral metastases, distinguishing this group from the good-prognosis category.
Defining Criteria — All Must Be Present
- Seminoma histology
- Any primary site
- Nonpulmonary visceral metastases
- Normal AFP (alpha-fetoprotein)
- Any hCG level
- Any LDH level
Treatment Approach
The standard treatment for this intermediate-prognosis group involves cisplatin-based combination chemotherapy given over multiple cycles, with an alternative combination available when one of the standard agents is contraindicated.
The complete regimen, agent selection criteria, and clinical decision pathway are in the full protocol.
Clinical Goals
Normalization of serum tumour markers; complete or partial radiological response.
References
- All of the following criteria: Any primary site, Nonpulmonary visceral metastases, Normal AFP, Any hCG, Any LDH.
- For patients with intermediate-risk seminoma, BEP x 4 is the standard regimen.
- If bleomycin is contraindicated, the combination of etoposide, cisplatin, ifosfamide (VIP) should be given.
View source ↗