[The current therapeutic strategy in testicular cancer]

In many countries the testicular cancer is the most frequent tumour in males aged between 15 and 35 years. Overall cure rates for patients with disseminated testicular cancer exceed 80%, and patients with local or local/regional disease are cured nearly 100%. For clinical purpose, germ cell tumours of the testis (GCT) are classified as seminomas (TS) or non-seminomas (TNS). Radical inguinal orchiectomy without scrotal violation has to be performed always. The treatment differs according to the disease state. In metastatic disease (stage II-III), according to the prognosis, patients are classified in good-risk and poor-risk groups. Chemotherapy is very active in testicular tumours and it is curative in advanced stage seminoma, good-risk metastatic non-seminomatous GCT as well as in the stage II disease. Etoposide, Bleomycin and Cisplatin based combination chemotherapy (BEP) and surgical removal of residual disease is now the standard treatment of metastatic germ cell tumors. Standard treatment, including three cycles of BEP for good-risk and four cycles of BEP for poor-risk patients, allows 95% and 65% respectively cure rate in these groups. However, about 10% of the patients achieving complete remission after first line chemotherapy eventually relapse. In refractory patients, high-dose chemotherapy and autologous bone marrow transplantation induces a potentially long-term nonevolutive disease rate. This appears to be the maximum effect that can be achieved. The scrupulous practice of the standard is the guarantee for sustained high cure rates.