Abstract：
OBJECTIVE: - To update French guidelines concerning testicular germ cell cancer.
METHODS: - Comprehensive Medline search between 2018 and 2020 upon diagnosis, treatment and follow-up of testicular germ cell cancer and treatments toxicities. Level of evidence was evaluated.
RESULTS: - Testicular Germ cell tumor diagnosis is based on physical examination, biology tests (serum tumor markers AFP, hCGt, LDH) and radiological assessment (scrotal ultrasound and chest, abdomen and pelvis computerized tomography). Total inguinal orchiectomy is the first-line treatment allowing characterization of the histological type, local staging and identification of risk factors for micrometastases. In case of several therapeutic options, one must inform his patient balancing risks and benefits. Surveillance is usually chosen in stage I seminoma compliant patients as the evolution rate is low between 15 to 20%. Carboplatin AUC7 is an alternative option. Radiotherapy indication should be avoided. In stage I non seminomatous patients, either surveillance or risk-adapted strategy can be applied. Staging retroperitoneal lymphadenectomy has restricted indications. Metastatic germ cell tumors are usually treated by PEB chemotherapy according to IGCCCG prognostic classification. Lombo-aortic radiotherapy is still a standard treatment for stage IIA. Residual masses should be evaluated by biological and radiological assessment 3 to 4 weeks after the end of chemotherapy. Retroperitoneal lymphadenectomy is advocated for every non seminomatous residual mass more than one cm. 18FDG uptake should be evaluated for each seminoma residual mass more than 3 cm.
CONCLUSIONS: - A rigorous use of classifications is mandatory to define staging since initial diagnosis. Applying treatments based on these classifications leads to excellent survival rates (99% in CSI, 85% in CSII+).
METHODS: - Comprehensive Medline search between 2018 and 2020 upon diagnosis, treatment and follow-up of testicular germ cell cancer and treatments toxicities. Level of evidence was evaluated.
RESULTS: - Testicular Germ cell tumor diagnosis is based on physical examination, biology tests (serum tumor markers AFP, hCGt, LDH) and radiological assessment (scrotal ultrasound and chest, abdomen and pelvis computerized tomography). Total inguinal orchiectomy is the first-line treatment allowing characterization of the histological type, local staging and identification of risk factors for micrometastases. In case of several therapeutic options, one must inform his patient balancing risks and benefits. Surveillance is usually chosen in stage I seminoma compliant patients as the evolution rate is low between 15 to 20%. Carboplatin AUC7 is an alternative option. Radiotherapy indication should be avoided. In stage I non seminomatous patients, either surveillance or risk-adapted strategy can be applied. Staging retroperitoneal lymphadenectomy has restricted indications. Metastatic germ cell tumors are usually treated by PEB chemotherapy according to IGCCCG prognostic classification. Lombo-aortic radiotherapy is still a standard treatment for stage IIA. Residual masses should be evaluated by biological and radiological assessment 3 to 4 weeks after the end of chemotherapy. Retroperitoneal lymphadenectomy is advocated for every non seminomatous residual mass more than one cm. 18FDG uptake should be evaluated for each seminoma residual mass more than 3 cm.
CONCLUSIONS: - A rigorous use of classifications is mandatory to define staging since initial diagnosis. Applying treatments based on these classifications leads to excellent survival rates (99% in CSI, 85% in CSII+).
摘要：
目的：-更新法国关于睾丸生殖细胞癌的指南。
方法：-诊断后的2018年至2020年之间的综合Medline搜索，睾丸生殖细胞癌和治疗毒性的治疗和随访。评估了证据水平。
结果：-睾丸生殖细胞瘤的诊断基于体格检查，生物学测试(血清肿瘤标志物AFP，hCGt,LDH）和放射学评估（阴囊超声和胸部，腹部和骨盆计算机断层扫描）。全腹股沟睾丸切除术是一线治疗，可以表征组织学类型，局部分期和微转移危险因素的识别。如果有几种治疗选择，必须告知患者平衡风险和收益。通常在I期精原细胞瘤依从性患者中选择监测，因为其演变率低，介于15％至20％之间。卡铂AUC7是一种替代选择。应避免放疗指征。在I期非精原细胞瘤患者中，可以应用监测或风险适应策略。分期腹膜后淋巴结清扫术的适应症有限。转移性生殖细胞肿瘤通常根据IGCCCG预后分类通过PEB化疗来治疗。Lombo主动脉放疗仍然是IIA期的标准治疗方法。化疗结束后3至4周，应通过生物学和放射学评估来评估残留肿块。对于每超过1厘米的非精原细胞瘤残留肿块，提倡腹膜后淋巴结清扫术。对于每个精原细胞瘤残留块超过3cm，应评估18FDG的摄取。
结论：—从最初诊断开始，严格使用分类是定义分期的必要条件。应用基于这些分类的治疗可带来出色的生存率（CSI中为99％，CSII+中的85%)。
方法：-诊断后的2018年至2020年之间的综合Medline搜索，睾丸生殖细胞癌和治疗毒性的治疗和随访。评估了证据水平。
结果：-睾丸生殖细胞瘤的诊断基于体格检查，生物学测试(血清肿瘤标志物AFP，hCGt,LDH）和放射学评估（阴囊超声和胸部，腹部和骨盆计算机断层扫描）。全腹股沟睾丸切除术是一线治疗，可以表征组织学类型，局部分期和微转移危险因素的识别。如果有几种治疗选择，必须告知患者平衡风险和收益。通常在I期精原细胞瘤依从性患者中选择监测，因为其演变率低，介于15％至20％之间。卡铂AUC7是一种替代选择。应避免放疗指征。在I期非精原细胞瘤患者中，可以应用监测或风险适应策略。分期腹膜后淋巴结清扫术的适应症有限。转移性生殖细胞肿瘤通常根据IGCCCG预后分类通过PEB化疗来治疗。Lombo主动脉放疗仍然是IIA期的标准治疗方法。化疗结束后3至4周，应通过生物学和放射学评估来评估残留肿块。对于每超过1厘米的非精原细胞瘤残留肿块，提倡腹膜后淋巴结清扫术。对于每个精原细胞瘤残留块超过3cm，应评估18FDG的摄取。
结论：—从最初诊断开始，严格使用分类是定义分期的必要条件。应用基于这些分类的治疗可带来出色的生存率（CSI中为99％，CSII+中的85%)。
