Retroperitoneal lymphadenectomy and aggressive chemotherapy in nonbulky clinical stage II nonseminomatous germinal testis tumors

Abstract

In a former series of 60 resected Stage II nonseminomatous germinal testis tumors the authors succeeded in demonstrating that adjuvant cisplatin, vinblastine, and bleomycin (PVB) was able to significantly improve survival (100% in 11 treated versus 28.5% in 7 historical controls, P < 0.01) only in patients with retroperitoneal metastases > 5 cm, macroscopic extranodal spread, tumor invasion into retroperitoneal veins (pathologic Stage II‐C). Forty‐eight evaluable patients with clinical nonbulky Stage II nonseminomatous testis cancer underwent retroperitoneal lymphadenectomy as primary treatment. Four courses of postoperative PVB were administered only to 18 clinically understaged patients (14 pathologic Stage II‐C, and 4 postoperatively reclassified as Stage III). The remaining 30 patients were followed at monthly intervals. After a median follow‐up of 25 months, relapses were: 1 (10%) in 10 pathologic Stage I patients; 8 (40%) in 20 pathologic Stage II‐A and II‐B; null in the 18 treated. Eight of the nine patients (89%) who had relapse entered continuous complete remission following salvage therapy. The overall 2‐year disease‐free survival in this case series is 98%. Retroperitoneal lymphadenectomy followed by compulsive follow‐up and selective use of aggressive chemotherapy is an alternative to remission induction chemotherapy as primary treatment in clinical nonbulky Stage II nonseminomatous testis cancer, and to immediate adjuvant chemotherapy in all patients with resected Stage II disease. Cancer 53:1363‐1368, 1984.

Testicular Carcinoma: A curable malignancy

“…There are data which suggest that cytotoxic drugs given adjuvant to surgery improve the prognosis, especially for patients with more advanced stages (stage I1 B and I1 C) (102,104,118,120,124). There are, however, also reports which suggest that a thorough follow-up with intensive therapy of recurrences while they are small, yields similar results (91,133). Thus in a series of 136 patients with non-seminomas in stage I and 11, 134 patients were alive several years after treatment with retroperitoneal lymph node extirpation and chemotherapy given only on demand (133).…”

“…In stage I1 40 to 60 per cent of the patients are cured by surgery alone (91,131). There are data which suggest that cytotoxic drugs given adjuvant to surgery improve the prognosis, especially for patients with more advanced stages (stage I1 B and I1 C) (102,104,118,120,124).…”