Management of Stages I and II Nonseminomatous Germ Cell Tumors of the Testis

Abstract

Management of Stages I and II nonseminomatous tumors of the testis is in a state of flux as a result of improvement in the major modalities for patient treatment. Both radiotherapy and retroperitoneal lymphadenectomy, used alone, are providing five-year survival rates in the range of 75 to 90% for patients with localized disease (Stage 1). However, since current staging methods fail to detect regional disease (Stage II) in 15 to 20% of the patients before therapy, lymphadenectomy provides a distinct and additional advantage, both by removing possible unseen metastases and by determining pathologically which patients may benefit from adjuvant therapy. Both surgery and radiotherapy, when used alone to combat extensive retroperitoneal disease, have proved unsatisfactory; surgery is frequently difficult or impossible, and persistent disease is common following radiotherapy. Therefore, patients with extensive Stage II disease are best treated with either preoperative chemotherapy or preoperative radiotherapy (2500 to 3000 rads over three to four weeks) before resection of the retroperitoneal disease. The benefits of adjuvant chemotherapy for patients with Stages I and II disease is under continuing investigation.