For the 2018 Testicular Cancer Guidelines, new references have been added throughout the document. Key changes in this publication include:
- Section 6.1 - Risk factors for metastatic relapse in clinical stage I was updated by means of a systematic review.
7.2.1.5 Guidelines for the treatment of stage I seminoma
| Recommendation | Strength rating |
| Fully inform the patient about all available management options, including surveillance or adjuvant chemotherapy after orchiectomy, as well as treatment-specific recurrence rates and acute and long-term side effects. | Strong
|
7.2.2.6 Risk-adapted treatment for clinical stage 1 based on vascular invasion
| Recommendation | Strength rating |
| Stage 1B (pT2-pT4): high risk | |
| Offer primary chemotherapy with one course of BEP, or surveillance. | Strong |
BEP = bleomycin, etoposide and cisplatin.
7.4.6 Guidelines for the treatment of metastatic germ cell tumours
| Recommendations | Strength rating |
| In metastatic NSGCT with a poor prognosis, treat with one cycle of BEP, or PEI in case of poor lung function, followed by tumour marker assessment after three weeks. In case of a favourable marker decline, continue BEP (or PEI) up to a total of four cycles. In case of an unfavourable decline, initiate chemotherapy intensification. | Strong
|
| In CS IIA seminoma, offer radiotherapy or chemotherapy and inform the patient of possible undesirable long-term side effects of both management options. | Strong
|
| Initially offer chemotherapy in seminoma stage CS IIB (BEP x 3 or EP x 4, in good prognosis) as an alternative to radiotherapy. | Strong
|
BEP = bleomycin, etoposide and cisplatin; PEI = cisplatin, etoposide and ifosfamide.