93.3 🩺 內科專科考前版

93.3.0.1 📌 䞀頁重點

  • 22E:
    • Active surveillance standard for Stage I (high cure rate, avoid late toxicity)
    • Sperm cryopreservation mandatory pre-chemo
    • BEP still standard; immune therapy emerging trials
    • Late relapse + late toxicity surveillance lifelong
  • Taiwan: 健保 BEP/VIP/TIP 充分; 健保 sperm cryopreservation 條件; 健保 RPLND + post-chemo surgery; 健保 high-dose chemo + autoHSCT 條件

93.3.0.2 🌟 Pearls (10)

  1. Active surveillance Stage I: cure 99%+ with simple protocol
  2. Cisplatin pre-treatment hydration + mannitol for nephroprotection
  3. Bleomycin avoidance in renal failure or pulmonary disease (use VIP instead)
  4. Late toxicity from BEP: secondary cancers, CV, neurotoxicity, hypogonadism, infertility
  5. Lifelong surveillance: imaging + markers; late relapse possible 5-10 yr
  6. Post-chemo residual mass NSGCT: surgical resection (teratoma 30%, necrosis 50%, viable 15%)
  7. High-dose chemo + autoHSCT salvage cure ~ 50%
  8. Brain mets aggressive treatment (RT + chemo + surgery)
  9. Burned-out testicular tumor: regressed primary; retroperitoneal mass; markers; consider as part of differential
  10. Klinefelter + extragonadal germ cell tumor: mediastinal (poor risk)

93.3.0.3 📍 Taiwan + 健保

  • 健保 inguinal radical orchiectomy
  • 健保 BEP, VIP, TIP, VeIP regimens
  • 健保 RPLND
  • 健保 carboplatin alternative (selected)
  • 健保 high-dose chemo + autoHSCT 條件
  • 健保 RT for seminoma 條件
  • Sperm cryopreservation 健保 + 自費 (健保 cancer-related limited)

93.3.0.4 🎓 內專必懂 (10)

  1. Markers + interpretation (AFP NEVER pure seminoma)
  2. Inguinal radical orchiectomy approach
  3. IGCCCG risk stratification
  4. Stage-based treatment (BEP cycles)
  5. Active surveillance protocols
  6. Salvage + autoHSCT
  7. Post-chemo RPLND for residual
  8. Late toxicity surveillance
  9. Sperm preservation + fertility planning
  10. Brain mets + extragonadal management

⚠ AI 草皿。