IGCCCInternational Germ Cell Consensus Classification (metastatic cancer)
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According to International Germ Cell Cancer Consensus Classification (IGCCC), majority of patient group was intermediate risk (55%) followed by poor risk (41.7%).
The baseline tumor stage, IGCCC risk groups and postchemotherapy residuals' histology (viable vs.
Cryptoorchidism was seen in 12% of our patient group, which was consistent with international data.9 Unfortunately, majority of NGCT patients were advanced stage and were intermediate or poor according to IGCCC risk group; however the DFS and OS rates were not dismal, i.e.
In patients with IGCCC "intermediate" or "poor" prognosis disease, 4 cycles of the BEP are considered the standard therapy.[sup.108,109] etoposide, ifosfamide and cisplatin (VIP) has been compared to BEP in this patient population and shows similar cancer outcomes but more genitourinary toxicity and myelosuppression and, thus, represents an alternative to BEP for patients with a contraindication to bleomycin or who develop pulmonary compromise while receiving BEP.[sup.110] For "intermediate" or "poor" prognosis patients, there is no evidence to date that the use of high-dose chemotherapy with autologous stem cell transplant is superior to standard BEP for 4 cycles.[sup.111,112] When chemotherapy is given, it should be given without dose reductions at 21-day intervals.
Patients with IGCCC good-risk disease should receive 3 cycles of BEP.
Patients with IGCCC intermediate and poor-risk disease should receive 4 cycles of BEP.