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NCCN Flash Update: NCCN Guidelines® and NCCN Compendium® Updated

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), NCCN Guidelines® with NCCN Evidence Blocks™, and NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Testicular Cancer. These NCCN Guidelines are currently available as Version 1.2017.  

  • Workup for suspicious testicular mass (TEST-1)
    • “Chest x-ray” was removed.
  • Post-diagnostic workup
    • Pure seminoma (TEST-2)
      • “Chest x-ray” was added.
      • “Bone scan, if clinically indicated” was removed.
      • Footnote h was added: “Eg, high beta-hCG, extensive lung metastasis, or choriocarcinoma.”
      • Footnote i was added: “For select cases of clinical stage IIA disease with borderline retroperitoneal lymph nodes, waiting 4-6 weeks and repeating imaging (chest/abdomen/pelvic CT) to confirm staging before initiating treatment can be considered.”
    • Nonseminoma (TEST-6)
      • 1st bullet was revised: “Chest/abdominal/pelvic CT ± chest imaging.”
      • “Bone scan, if clinically indicated” was removed.
  • Pure seminoma, Primary treatment
    • For Stage IA, IB, the RT recommendation was revised: “RT (20 Gy, preferred or 25.5 Gy). (TEST-3)
    • For Stage IIA, “preferred” was removed from the RT recommendation. (TEST-4)
    • For Stage IIB, RT was revised by clarifying non-bulky, “RT in select non-bulky (≤3 cm) cases...” (TEST-4)
    • For Stage IIC, III, chemotherapy for intermediate risk was revised by adding, “VIP for 4 cycles.” (TEST-4)
  • Pure seminoma, Post-chemotherapy (TEST-5)
    • For residual mass (>3 cm) and normal markers, positive PET
      • Algorithm was revised by replacing “Consider RPLND, if technically feasible or Second-line chemotherapy” with “Resection of residual mass or biopsy” followed by:
        • Positive for viable seminoma to second-line chemotherapy
        • Negative for viable seminoma for See Follow-up for Seminoma
    • Footnote r was added: "If complete resection of all residual disease, consider chemotherapy for 2 cycles (EP or TIP or VIP/VeIP). If resection incomplete, consider full course of second-line therapy (see TEST-12)." (TEST-5)
  • Nonseminoma, Primary treatment
    • For Stage IA, BEP for 1 cycle was added as an option. (TEST-7)
    • For Stage IB, surveillance was revised, “Surveillance for T2 or T3 only (category 2B).”
  • Nonseminoma, Post-chemotherapy (TEST-11)
    • For Stage IIC, IIIB, chemotherapy for intermediate risk was revised by adding, “VIP for 4 cycles.” 
  • Nonseminoma, Second-line therapy (TEST-12)
    • For unfavorable prognosis, the option for high-dose chemotherapy was changed from a category 2B to a category 2A.
  • Follow-up
    • The statement at the top of the page was revised as follows, “No single follow-up plan is appropriate for all patients. The follow-up for seminoma tables are to provide guidance, and should be modified for the individual patient based upon sites of disease, biology of disease, and length of time on treatment and may be extended beyond 5 years at the discretion of the physician. Reassessment of disease activity should be performed in patients with new or worsening signs or symptoms of disease, regardless of the time interval from previous studies. Further study is required to define optimal follow-up duration.” (TEST-A 1 of 2) (Also revised for nonseminoma on TEST-B 1 of 3)

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Compendium®, and the NCCN Chemotherapy Order Templates (NCCN Templates®), please visit

To access the NCCN Biomarkers Compendium™, please visit

To view the NCCN Guidelines for Patients®, please visit

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