[Chemotherapy of testicular cancer]

The incidence of testicular tumours is low. It is the most frequent tumour among men between the age of 15 and 44. A risk factor for a testicular tumour is abnormal development of a testicle, for example cryptorchidism. In case of doubt about the diagnosis a scrotal sonography is nearly 100% accurate. The treatment and final prognosis are determined by the histological type and presence or absence of retroperitoneal and/or lung metastasis. Two-thirds of the patients have a chance of cure of over 90%. Standard treatment for a patient with a metastasized non-seminoma and the more extensive forms of metastasized seminoma is chemotherapy with 4 courses of bleomycin, etoposide and cisplatin. Long-term side effects are limited to polyneuropathy in hands and feet in some of the patients. Reduction in fertility appears to be temporarily, the risk for offspring seems nil. In good prognosis patients toxicity can be decreased by reduction of the number of chemotherapy cycles or of the dose of bleomycin. In the poor prognosis subset new drugs may improve the prognosis but to date clear results are lacking. Second-line chemotherapy is only possible with attention for the cumulative bone marrow toxicity; autologous bone marrow rescue or growth factors can diminish this.