Management of NSGCT following radical orchiectomy*

NSGCT: nonseminomatous germ cell tumor; AFP: alpha-fetoprotein; hCG: human chorionic gonadotropin; CT: computed tomography; LVI: lymphovascular invasion; LDH: lactate dehydrogenase; ULN: upper limit of normal; BEP: bleomycin, etoposide, and cisplatin; RPLND: retroperitoneal lymph node dissection; VIP: etoposide, ifosfamide, and cisplatin; EP: etoposide and cisplatin; MRI: magnetic resonance imaging.
* Patients with pure seminoma on pathology but with an elevated AFP are considered to have NSGCT.
¶ Inguinal or pelvic lymph nodes are classified as distant metastases and constitute stage III disease.
Δ Treatment for systemic disease is discussed in the topic on risk stratification and treatment of advanced disease.
◊ Involved lymph nodes are those with a short axis ≥10 mm.
§ All options are associated with a very high probability of cure. Choice is based upon a consideration of patient preference and available expertise.
¥ If RPLND is negative or reveals only teratoma, no further therapy is indicated. For men with tumors containing elements of embryonal carcinoma, seminoma, yolk sac tumor, and/or choriocarcinoma, options include either adjuvant chemotherapy or careful surveillance. Refer to discussion in the topic on stage II NSGCT.
‡ RPLND should be limited to centers with adequate surgical expertise.
† Further evaluation should include MRI of the brain to rule out brain metastases.