Devita, Hellman, and Rosenberg's Cancer

LWBK1006-22 LWW-Govindan-Review December 12, 2011 19:7

302 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

risk of relapse and the high probability of cure with treatment of relapsed

disease, observation after orchiectomy remains an alternative option.

RPLND is usually not recommended in the management of patients with

seminoma.

Answer 22.8. The answer is D.

After orchiectomy, the probability of relapse for patients with seminoma

under surveillance is between 15% and 20%. The relapse, however, is

typically 12 to 15 months longer than for nonseminomatous tumors,

with the relapse rate after 2 and 5 years approximately 30% and 5%,

respectively.

Answer 22.9. The answer is A.

Historically, patients with clinical stage I disease were treated with a

retroperitoneal lymph node dissection, and 30% of patients were found

to have occult retroperitoneal disease. This rate may be dependent on

the pathological stage, ranging from 15% in patients with T1 (stage IA)

to 50% in patients with stage T2 or higher (stage IB). However, since

chemotherapy is highly effective for treating recurrent disease, obser-

vation is a reasonable treatment option, with chemotherapy in case of

recurrence. Radiation therapy has no role in the management of stage

I NSGCTs as they are not very radiosensitive. Virtually all patients

who undergo full bilateral RPLND have retrograde ejaculation; however,

nerve-sparing RPLND has eliminated this complication.

Answer 22.10. The answer is B.

In patients with advanced good-risk germ cell tumors, acceptable

chemotherapy regimens include three cycles of BEP, or four cycles of

EP. Carboplatin should not be substituted for cisplatin in patients with

testicular cancer.

Answer 22.11. The answer is D.

Although either mediastinal primary site or brain metastases define poor-

risk nonseminomas, the poor-risk category is not applicable for semino-

mas. Furthermore, whereas the presence of nonpulmonary visceral metas-

tases, such as brain metastases, classifies seminomas as intermediate risk,

primary mediastinal seminomas remain in the good-risk category.

Answer 22.12. The answer is B.

Patients with intermediate-risk nonseminomas should have AFP between

1000 and 10,000 ng/mL, HCG between 5000 and 50,000 mIU/mL, LDH

between 1.5 and 10 times the upper normal limit, primary site gonadal

or retroperitoneal, and no visceral metastases other than pulmonary.

Answer 22.13. The answer is D.

The International Germ Cell Cancer Collaborative Group (IGCCCG)

staging system stratifies patients with seminoma into two categories: good