Salvage therapy in testicular cancer

Yoshihiko Hirao, Emeritus Nara Medical University

【 Introduction 】 Most of advanced testicular cancer are respond well to CDDP

combined chemotherapy, so salvage treatment in testicular cancer is target the
patient with residual cancer after induction chemotherapy.
Multidisciplinary approach is mandatory for salvage therapy based on the strict
strategy using tumor markers and image diagnosis, and salvage chemotherapy
and/or surgical resection, even radiotherapy should be selected and performed
carefully.
【 Salvage chemotherapy 】 The observation strategy, salvage chemotherapy only
performed after confirmation of progressive disease on tumor makers and/or
diagnostic imaging, are widely accepted. The regime for salvage chemotherapy
should be selected depending on the reactivity to CDDP which used in induction
chemotherapy
【 Surgical resection 】 Retroperitoneal lymph node dissection (RPLND) are
standard to the most frequent residual metastatic site. In case of seminoma, active
surveillance is indicated for residual tumor under 3cm in diameter, and RPLND
for tumor over 3cm in general. In case of non-seminoma, RPLND is indicated for
residual tumor over 1cm, and RPLND is controversial for tumor under 1cm.
Surgical resection of multiple visceral metastasis other than RPLN and
desperation surgery for the case with non-normalized tumor markers, do not
reach the adequate consensus at present.
【Radiation therapy 】Except for seminoma stage 1, 2, there are no high level of
the evidences for radiotherapy to germ cell tumor, and the role of radiation
therapy against residual and/or recurrent testicular tumor are left vague. Novel
radiotherapy such as IM-RT might be useful for localized residual RPLN after
RPLND.
【Conclusion】 Salvage therapy against residual/recurrent testicular cancer after
induction chemotherapy keep on evolving step-by-step.