A 35-year-old man presents with a painless left testicular mass. Beta-hCG is 2400 mIU/mL and AFP is 180 ng/mL. CT shows no retroperitoneal lymphadenopathy and no pulmonary metastases. Orchidectomy confirms a mixed germ cell tumour (teratoma + embryonal carcinoma). Pathological stage is pT2 N0 M0 S2 (IGCCC intermediate risk). The recommended post-orchidectomy management is:
- A BEP chemotherapy (3–4 cycles) ✓
- B Surveillance alone
- C One cycle of adjuvant carboplatin
- D Retroperitoneal lymph node dissection (RPLND) alone
Correct answer: A. BEP chemotherapy (3–4 cycles)
Explanation
IGCCC intermediate-risk non-seminomatous GCT (Stage IS with S2 markers) requires systemic chemotherapy; the standard regimen is 4 cycles of BEP (bleomycin, etoposide, cisplatin) or 3 cycles in good-risk disease. Surveillance is inappropriate for stage IS (persistently elevated markers post-orchidectomy). Adjuvant carboplatin is used for stage I seminoma, not NSGCT.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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