[Treatment decision in advanced testicular germ cell tumors]

To review the classifications of the risk groups of different prestigious institutions and collaborative groups that have had a major impact on our knowledge and therapeutic approach to germ cell tumors of the testis.

We reviewed the different classifications of renowned institutions and collaborative groups and the literature published over the last 15 years that provide evidence for the optimal therapeutic approach for each subgroup at risk.

Germ cell testicular tumors is the paradigm of curable tumors of the adult. Patients with stage I tumors have an excellent prognosis with more than 98% probability of cure. The prognosis for the advanced stage tumors is superior to that of other solid tumors with a similar volume due to their exquisite chemosensitivity. Patients with advanced disease can be divided into two or three groups (low and high, or low, intermediate and high risk) with different probability of cure after treatment with cisplatin-based regimens, according to the location of the primary tumor, extent of the disease and serum levels of the markers. The standard treatment for the advanced disease consists of first line chemotherapy with cisplatin, etoposide and bleomycin (BEP) followed by surgery in cases with residual tumor. Approximately 10% of the patients with good-prognosis factors and 30%-50% of those with poor-prognosis factors will not cure after first line chemotherapy, although rescue with second line chemotherapy can be utilized in some of these patients. The search for more effective chemotherapeutic regimens for high risk patients and regimens with a lower toxicity for the low risk patients has been hampered by the lack of consensus among the working groups on the criteria for the classification of these patients into subgroups according to prognosis. The recent International Germ Cell Consensus Classification will permit studies on homogeneous risk groups of patients and will allow us to obtain reliable and reproducible results.