Treatment of Clinical Stage II (CS II) Disease in Testicular Cancer

  • Christian Winter
Living reference work entry


Testicular cancer represents the most common solid malignancy of young men aged 15–40 years. Germ cell tumors are best divided into those with pure seminoma and non-seminoma histology. The treatment of metastatic testicular germ cell tumors is based on risk stratification according to histological feature, clinical stages and IGCCCG classification. Clinical stage II disease (CS II) is defined by the presence of testicular cancer in the orchiectomy specimen and imaging studies of the abdomen and pelvis that show positive regional lymph nodes. Other potential sites of metastasis, such as the chest, are free of disease. About 10–30 percent of patients with seminoma and non-seminoma have stage CS II disease at clinical presentation. These patients with lymphatic metastasis should be treated with individualized risk-stratification and within a multidisciplinary approach of chemotherapy, radiotherapy and surgery at centres of excellence.


  1. Albers P, et al. Guidelines on testicular cancer: 2015 update. Eur Urol. 2015;68(6):1054–68.CrossRefGoogle Scholar
  2. Andre F, et al. The growing teratoma syndrome: results of therapy and long-term follow-up of 33 patients. Eur J Cancer. 2000;36(11):1389–94.CrossRefGoogle Scholar
  3. Beyer J, et al. Maintaining success, reducing treatment burden, focusing on survivorship: highlights from the third European consensus conference on diagnosis and treatment of germ-cell cancer. Ann Oncol. 2013;24(4):878–88.CrossRefGoogle Scholar
  4. Bosl GJ, Motzer RJ. Testicular germ-cell cancer. N Engl J Med. 1997;337(4):242–53.CrossRefGoogle Scholar
  5. Chung PW, et al. Stage II testicular seminoma: patterns of recurrence and outcome of treatment. Eur Urol. 2004;45(6):754–9. discussion 759–60CrossRefGoogle Scholar
  6. Classen J, et al. Radiotherapy for stages IIA/B testicular seminoma: final report of a prospective multicenter clinical trial. J Clin Oncol. 2003;21(6):1101–6.CrossRefGoogle Scholar
  7. Culine S, et al. Randomized trial comparing bleomycin/etoposide/cisplatin with alternating cisplatin/cyclophosphamide/doxorubicin and vinblastine/bleomycin regimens of chemotherapy for patients with intermediate- and poor-risk metastatic nonseminomatous germ cell tumors: Genito-Urinary Group of the French Federation of Cancer Centers Trial T93MP. J Clin Oncol. 2008;26(3):421–7.CrossRefGoogle Scholar
  8. de Wit R, et al. Four cycles of BEP versus an alternating regime of PVB and BEP in patients with poor-prognosis metastatic testicular non-seminoma; a randomised study of the EORTC Genitourinary Tract Cancer Cooperative Group. Br J Cancer. 1995;71(6):1311–4.CrossRefGoogle Scholar
  9. Decoene J, Winter C, Albers P. False-positive fluorodeoxyglucose positron emission tomography results after chemotherapy in patients with metastatic seminoma. Urol Oncol. 2015;33(1):23.e15–21.CrossRefGoogle Scholar
  10. Fossa SD, et al. Intensive induction chemotherapy with C-BOP/BEP for intermediate- and poor-risk metastatic germ cell tumors (EORTC trial 30948). Br J Cancer. 2005;93(11):1209–14.CrossRefGoogle Scholar
  11. Garcia-del-Muro X, et al. Chemotherapy as an alternative to radiotherapy in the treatment of stage IIA and IIB testicular seminoma: a Spanish Germ Cell Cancer Group Study. J Clin Oncol. 2008;26(33):5416–21.CrossRefGoogle Scholar
  12. Hinz S, et al. The role of positron emission tomography in the evaluation of residual masses after chemotherapy for advanced stage seminoma. J Urol. 2008;179(3):936–40, discussion 940CrossRefGoogle Scholar
  13. Horwich A, et al. Neoadjuvant carboplatin before radiotherapy in stage IIA and IIB seminoma. Ann Oncol. 2013;24(8):2104–7.CrossRefGoogle Scholar
  14. Kollmannsberger C, et al. Evolution in management of testicular seminoma: population-based outcomes with selective utilization of active therapies. Ann Oncol. 2011;22(4):808–14.CrossRefGoogle Scholar
  15. Krege S, et al. Single agent carboplatin for CS IIA/B testicular seminoma. A phase II study of the German Testicular Cancer Study Group (GTCSG). Ann Oncol. 2006;17(2):276–80.CrossRefGoogle Scholar
  16. Krege S, et al. European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus group (EGCCCG): part I. Eur Urol. 2008a;53(3):478–96.CrossRefGoogle Scholar
  17. Krege S, et al. European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): part II. Eur Urol. 2008b;53(3):497–513.CrossRefGoogle Scholar
  18. Stephenson AJ, et al. Nonrandomized comparison of primary chemotherapy and retroperitoneal lymph node dissection for clinical stage IIA and IIB nonseminomatous germ cell testicular cancer. J Clin Oncol. 2007;25(35):5597–602.CrossRefGoogle Scholar
  19. Tandstad T, et al. Management of seminomatous testicular cancer: a binational prospective population-based study from the Swedish norwegian testicular cancer study group. J Clin Oncol. 2011;29(6):719–25.CrossRefGoogle Scholar
  20. Weissbach L, et al. RPLND or primary chemotherapy in clinical stage IIA/B nonseminomatous germ cell tumors? Results of a prospective multicenter trial including quality of life assessment. Eur Urol. 2000;37(5):582–94.CrossRefGoogle Scholar
  21. Winter C, Albers P. Testicular germ cell tumors: pathogenesis, diagnosis and treatment. Nat Rev Endocrinol. 2011;7(1):43–53.CrossRefGoogle Scholar
  22. Winter C, et al. Retroperitoneal lymph node dissection after chemotherapy. BJU Int. 2009;104(9 Pt B):1404–12.CrossRefGoogle Scholar
  23. Zengerling F, et al. German second-opinion network for testicular cancer: sealing the leaky pipe between evidence and clinical practice. Oncol Rep. 2014;31(6):2477–81.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of UrologyUniversity Hospital Düsseldorf/GermanyDüsseldorfGermany

Section editors and affiliations

  • Chris Protzel
    • 1
  • Axel Heidenreich
    • 2
  1. 1.Universitätsklinikum Rostock , Urologische Klinik und PoliklinikRostockGermany
  2. 2.Division of Oncological Urology, Department of UrologyUniversity of KölnKölnGermany

Personalised recommendations