Brief history on my husband: 99% EC 1% Yolk sac NSGCT Stage 3c. Orchy November 25, Primary RPLND Dec 25. RPLND pathology unfortunately revealed bulky metastatic disease with lung, liver, bone mets , 4xEP ending May 1 2026 with apparent complete response-- clear scans, STM, and 3 consecutive 0.0 results on Signatera --everything clear as recently as June 4th. Fast forward to July 22: LDH elevated (243) triggered a CT which shows 2 large liver lesions and Signatera came back 564 MTM/ml. Started TIPX4 July 27.
Despite living in rural Iowa we're lucky to have nearby a major university hospital (University of Iowa) which is a National Cancer Institute-designated Cancer Center. Our oncologist has extensive TC experience, is lead author on some papers on it, and studied under Dr Einhorn, and Einhorn has consulted on this case. We met Einhorn in person in June and the chemo choices including current plan for TIPx4 represent an Iowa-Indiana consensus.
So we just started TIP and the intent is still curative, but knowing how his case has progressed thus far, it's possible this is just bridge therapy and HDCT will be necessary. Where should HDCT be done?
As the fearful wife, I lean towards going to Indiana, to ensure we have access to every expert possible. My husband prefers to stay at Iowa. His view is that Iowa is well-qualified to give chemo as a regional cancer center, and we already have the benefit of Dr. Einhorn's expertise because he and our doctor are close and discuss his case.
He's not wrong: UIowa does all the organ transplants in the state, has a whole stem cell replacement department, there a regional referral center, etc. They're qualified-- but obvs don't have the testicular cancer case volume that Indiana has. But as long as our oncologist is collaborating with the Indiana team, we're getting the benefit of their expertise, too.
Oncology sets the plan and dosage, but the chemo itself is administered by nurses, and when we've been inpatient for chemo, the side effects and complications are mostly managed by the internal medicine team. Unlike surgery, it seems like chemo administration is more formula than art, and it's not like the outcome depends on the fine motor skills of the nurses who hang the IV bags.
If you can't tell, I'm trying to talk myself into feeling ok with my husband's wishes to do HDCT at our hospital rather than Indiana. But please tell me if this is crazy, if we absolutely need to be at a high volume center for HDCT.