2007 Systematic review: Primary treatments for testicular germ cell tumours after radical orchidectomy. Summary report [Synthèse méthodique des données scientifiques 2007: Traitements de première intention des tumeurs germinales du testicule après orchidectomie totale]

摘要

Background: The "Standards, Options and Recommendations" (SOR) programme in oncology, has been initiated in 1993 by the Federation of French Cancer Centres; today, it is placed under the authority of the French National cancer institute. In this context, a collaborative work of systematic review, of the management of non-seminomatous (NSTGC) or seminomatous (STGC) testicular germ cell cancer treated with primary radiotherapy (RT), chemotherapy (CT) or surveillance (SV) after radical orchidectomy is proposed by the SOR programme and the French Association of Urology. Method: A systematic literature search has been performed on Medline? between 01/2004 and 08/2007 and completed by a survey of Evidence-Based Medicine websites. Randomised controlled trial, systematic reviews, and observational studies carried out in patients with locally or advanced tumour have been included. Studies have been assessed for eligibility and quality by three independents reviewers. Conclusion: Twenty-nine trials were identified as eligible for this analysis. The choice of risk-adapted treatment for patients with locally NSTGC seems to be appropriate: SV for low-risk patients and CT for others. For advanced stage tumours, the suppression of bleomycine remains questionable. For local STGC, the choice of SV or CT versus RT needs to be confirmed by RCT with prolonged follow-up given the promising results regarding the treatment toxicity obtained with carboplatine or lower irradiation dose (20 Gy instead of 30 Gy). For advanced STGC, the usefulness of a carboplatine single agent treatment versus cisplatin-based combination chemotherapy has not been proved.