The clinical features and management of testicular germ cell tumours in patients aged 60 years and older

OBJECTIVES To review the practice of a large referral centre for the management of older patients with testicular germ cell cancer (GCC). There are few published data available on the management of testicular GCC in elderly patients, who often have medical comorbidities and have been excluded from clinical trials. PATIENTS AND METHODS We reviewed our prospectively collected database for patients presenting with GCC who were aged >= 60 years. Details of presentation, management and outcome were recorded. RESULTS In total, 60 patients aged >= 60 years were identified from 1461 patients treated with GCC from 1979-2005, representing 4% of the total population. Median age was 67 years, 44 had seminoma (73%) and 16 had non-seminoma histology (27%). Stage I seminoma patients were managed with surveillance, adjuvant radiotherapy and adjuvant carboplatin. All stage I non-seminomas underwent surveillance. In total, 15 patients received systemic chemotherapy for metastatic disease with modified bleomycin, etoposide and cisplatin; etoposide and cisplatin; carboplatin-based regimens; or other combinations. Toxicity was manageable, with no toxic deaths. In total, four patients (6.7%) died of GCC. CONCLUSIONS In elderly patients, GCC should be managed with curative intent. Conventional therapies are tolerable for most men with stage I seminoma. In metastatic disease, comorbidity may necessitate treatment modifications. Most patients are cured with manageable toxicity.