背景:法国泌尿外科协会肿瘤学委员会的目的是建立外生殖器官小组提出的指南,为了诊断,睾丸生殖细胞肿瘤的治疗和随访。
方法:多学科工作组研究了2013年指南,详尽地回顾了文献,并评估参考文献及其证明水平,以确定推荐的等级。
结果:睾丸癌的初步检查是基于临床,实验室(法新社,总hCG,LDH)和影像学评估(阴囊超声和胸部,腹部和骨盆计算机断层扫描)。腹股沟睾丸切除术是允许表征组织学类型的一线治疗方法,局部分期和微转移危险因素的识别。I期肿瘤的管理基于监测或基于风险适应的方法,向患者解释作为复发风险的函数的积极治疗或观察等待的益处/缺点。I期精原细胞瘤的治疗选择包括:监测,化疗(1周期卡铂)或主动脉旁放疗。I期非精原细胞生殖细胞肿瘤的治疗选择包括:监测,化疗(1周期BEP)或分期腹膜后淋巴结清扫术。转移性肿瘤的治疗基本上包括3、4个周期的BEP化疗或根据IGCCCG的剂量密集化疗。淋巴结转移<3cm的精原细胞瘤可能需要放疗。化疗后3至4周的审查基本上基于肿瘤标志物测定和胸部,腹部和骨盆计算机断层扫描。对于所有>1cm的残留NSGCT肿块和>3cm的持续残留精原细胞瘤肿块,并伴有18F-FDGPET-CT摄取,应进行腹膜后淋巴结清扫术。
结论:良好的生殖细胞肿瘤特异性生存率(99%CSI,85%CSII,III)基于精确的初始分期,适应和严格定义的治疗和密切监测。©2016ElsevierMassonSAS。保留所有权利。
BACKGROUND: The purpose of the oncologic comitee of the french association of urology was to establish
guidelines proposed by the external genital organ group, for the diagnosis, treatment and follow-up of the germ cell tumours of the testis.
METHODS: The multidisciplinary working group studied 2013
guidelines, exhaustively reviewed the literature, and evaluated references and their level of proof in order to attribute grades of recommandation.
RESULTS: The initial workup of testicular cancer is based on clinical, laboratory (AFP, total hCG, LDH) and imaging assessment (scrotal ultrasound and chest, abdomen and pelvis computed tomography). Inguinal orchiectomy is the first line treatment allowing characterization of the histological type, local staging and identification of risk factors for micrometastases. The management of stage I tumors is based on surveillance or on a risk-adapted approach with explaining to the patient the benefits/disadvantages of active treatment or watchful waiting as a function of the risk of relapse. Treatment options for stage I seminomas comprise: surveillance, chemotherapy (1cycle of carboplatin) or para-aortic radiotherapy. Treatment options for stage I nonseminomatous germ cell tumours comprise: surveillance, chemotherapy (1cycle of BEP) or staging
retroperitoneal lymphadenectomy. The management of metastatic tumors essentially comprises chemotherapy with 3, 4 cycles of BEP or dose-dense chemotherapy according to the IGCCCG. Radiotherapy may be indicated in seminomas with lymph node metastasis < 3cm. Review 3 to 4 weeks postchemotherapy is essentially based on tumor marker assays and chest, abdomen and pelvis computed tomography. Surgical
retroperitoneal lymph node dissection is indicated for all residual NSGCT masses > 1cm and for persistent residual seminoma masses > 3cm with 18F- FDG PET- CT uptake.
CONCLUSIONS: Good Germ cell tumors specific survival rates (99% CSI, 85% CSII, III) are based on precise initial staging, adapted and strictly defined treatment and close surveillance. © 2016 Elsevier Masson SAS. All rights reserved.