Evolution and controversies in the management of low-stage nonseminomatous germ-cell tumors of the testis

G. Pizzocaro, N. Nicolai, R. Salvioni

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Abstract

The results of changing treatment modalities in 690 consecutive patients with low stages nonseminomatous germ-cell tumors (NSGCT) of the testis were analyzed. Overall, 120 patients (17.4%) suffered relapses, and 25 (3.6%) died of cancer after a follow-up period ranging from 2 to 20 years. The indications for primary (nerve-sparing) retroperitoneal lymph-node dissection (RPLND) were gradually restricted from clinical stages I, IIA, and IIB to stages I and IIA with normal postorchiectomy markers only, but we recognize that the management of clinical stage I NSGCT of the testis remains controversial. All other patients may be treated with primary chemotherapy followed by nerve-sparing RPLND for any residual mass. Adjuvant chemotherapy is mandatory in pathological stage IIC disease, but this pathological category will disappear with adoption of the restrictions for primary nerve-sparing RPLND, and two courses of adjuvant chemotherapy are adequate treatment for patients with pathological stages IIA and IIB disease, who cannot be carefully followed.

Original languageEnglish
Pages (from-to)113-119
Number of pages7
JournalWorld Journal of Urology
Volume12
Issue number3
DOIs
Publication statusPublished - Jun 1994

ASJC Scopus subject areas

  • Urology

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