OBJECTIVE: This article is a short version of the EAU testicular cancer guidelines and summarises the main conclusions from the guidelines on the management of testicular cancer.
METHODS: Guidelines were compiled by a multidisciplinary guidelines working group. A systematic review was carried out using Medline and Embase, also taking Cochrane evidence and data from the European Germ Cell Cancer Consensus Group into consideration. A panel of experts weighted the references, and a level of evidence and grade of recommendation were assigned.
RESULTS: There is a paucity of literature especially regarding longer term follow-up, and results from a number of ongoing trials are awaited. The choice of treatment centre is of the utmost importance, and treatment in reference centres within clinical trials, especially for poor-prognosis nonseminomatous germ cell tumours, provides better outcomes. For patients with clinical stage I seminoma, based on recently published data on long-term toxicity, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment. The TNM classification 2009 is recommended.
CONCLUSIONS: These guidelines contain information for the standardised management of patients with testicular cancer based on the latest scientific insights. Cure rates are generally excellent, but because testicular cancer mainly affects men in their third or fourth decade of life, treatment effects on fertility require careful counselling of patients, and treatment must be tailored taking individual circumstances and patient preferences into account.
CONCLUSIONS: Although testicular cancer has excellent cure rates, the choice of treatment centre is of the utmost importance. Expert centres achieve better results for both early stage testicular cancer (lower relapse rates) and overall survival (higher stages within clinical trials). For patients with clinical stage I seminoma, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment.
目的:本文是EAU睾丸癌指南的简短版本,总结了有关睾丸癌治疗指南的主要结论。
方法:指南由一个多学科指南工作组编制。使用Medline和Embase进行了系统评价,还考虑了Cochrane证据和欧洲生殖细胞癌症共识小组的数据。一个专家小组对参考文献进行了加权,并分配了证据水平和推荐等级.
结果:文献很少,特别是关于长期随访的文献,目前还在等待一些正在进行的试验的结果.治疗中心的选择至关重要,和临床试验中参考中心的治疗,尤其是预后不良的非精原细胞生殖细胞肿瘤,提供更好的结果。对于临床I期精原细胞瘤的患者,根据最近公布的长期毒性数据,辅助放疗不再推荐作为一线辅助治疗.建议使用2009年TNM分类。
结论:这些指南包含了基于最新科学见解的睾丸癌患者标准化管理信息。治愈率一般都很好,但是因为睾丸癌主要影响男性的第三或第四个十年,对生育能力的治疗效果需要对患者进行仔细的咨询,治疗必须根据个人情况和患者偏好进行调整。
结论:虽然睾丸癌有很好的治愈率,治疗中心的选择至关重要。专家中心在早期睾丸癌(较低的复发率)和总体生存率(临床试验中的较高阶段)方面都取得了更好的结果。对于临床I期精原细胞瘤的患者,辅助放疗不再推荐作为一线辅助治疗.