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COMMENTARY
Year : 2013  |  Volume : 5  |  Issue : 3  |  Page : 182-183  

Primary chemotherapy in management of tumors of undescended testis: Where it stands?


Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia

Date of Web Publication29-Jul-2013

Correspondence Address:
Christopher C. K. Ho
Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur
Malaysia
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PMID: 24049382

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How to cite this article:
Ho CC. Primary chemotherapy in management of tumors of undescended testis: Where it stands?. Urol Ann 2013;5:182-3

How to cite this URL:
Ho CC. Primary chemotherapy in management of tumors of undescended testis: Where it stands?. Urol Ann [serial online] 2013 [cited 2020 Sep 26];5:182-3. Available from: http://www.urologyannals.com/text.asp?2013/5/3/182/115744

The authors present their experience with primary chemotherapy in management of tumors of undescended testis which has extended beyond the testis (Stage 1B and above). After three cycles of bleomycin, etoposide, cisplatin (BEP) regime, complete response was seen in 11 cases and in three cases, there was partial response (decrease in size to 4-6 cm) where excision of the residual tumor along with retroperitoneal lymph node dissection (RPLND) was done. The outcome was good where 13 out of the 14 patients who were on follow up (mean 34.3 months) were doing well without recurrence.

In germ cell testicular tumors, 3-13% have a history of undescended testis. [1] Out of these, seminomas are more common accounting for 50-80% of cases. [2] According to the European Association of Urology (EAU) Guidelines, one course of carboplatin chemotherapy is recommended for stage I seminoma. For stage IIA/B, radiotherapy has been the standard treatment. However, for stage IIB and beyond, three cycles of BEP chemotherapy is recommended. [3] These are general recommendations for testicular tumor but not specifically for undescended testicular tumors.

In this study, all the tumors were seminomas and the tumors were located in the inguinal region or intra-abdominal, making orchidectomy almost impossible with the tumors already extending beyond the testis. Resection of the tumor will be difficult and entail a high degree of morbidity. Neo-adjuvant chemotherapy with subsequent resection of the tumor is the rational management. The other option is radiotherapy followed by resection as seminomas are radiosensitive. In an earlier report, 48.3% of seminomatous undescended testis tumor had complete response to chemotherapy while 37.9% had a partial response with residual tumor larger than 3 cm in the retro peritoneum. These latter patients however, had complete response after consolidation radiotherapy at 30 to 40 Gy. [4]

In this current study, what the authors showed was that BEP chemotherapy for seminomatous undescended testis tumor was safe and tolerable with good response. However, the sample size was small (14 cases). Therefore, the conclusion could not be generalized for all seminomatous undescended testicular tumors. A more robust study with longer follow up is needed. Nevertheless, the authors are to be commended for sharing their experience with this relatively rare and challenging subset of tumor, and their further follow-up of this group of patients would add to our knowledge. The key here is prevention, where early detection of undescended testis with pre-adolescent orchidopexy or post-adolescent orchidectomy, would be able to avert this potentially disastrous problem.

 
   References Top

1.Kulkarni JN, Kamat MR. Tumors in undescended testis. J Surg Oncol 1991;46:257-60.  Back to cited text no. 1
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2.Batata MA, Whitmore WF Jr, Chu FC, Hilaris BS, Loh J. Grabstald H, et al. Cryptorchidism and testicular cancer. J Urol 1980;124:382-7.  Back to cited text no. 2
    
3.Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K, et al. EAU guidelines on testicular cancer: 2011 update. Eur Urol 2011;60:304-19.  Back to cited text no. 3
[PUBMED]    
4.Kulkarni JN, Desai SM, Phadke GK, Tongaonkar HB. Improved management of abdominal undescended testicular tumors with bulky confluent retroperitoneal nodal metastases. J Urol 1996;156:1341-4.  Back to cited text no. 4
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