THE ROLE OF ADJUVANT TREATMENT IN LOW-STAGE GERM-CELL TESTICULAR-TUMORS

Objective: To find out up-to-date indications to adjuvant therapy in l ow-stage germ cell tumors (GCT) of the testis. Methods: The authors re viewed the material of the National Cancer Institute in Milan and the major international papers on adjuvant therapies of GCT of the testis. Results: Moderate dose irradiation of retroperitoneal nodes remains t he standard therapy of stage I seminoma; mediastinal irradiation has b een abandoned in stage II seminoma. Nerve-sparing retroperitoneal lymp h node dissection and surveillance remain standard therapies for nonse minomatous stage I tumors; 2 adjuvant courses of cisplatin-based chemo therapy are under investigation in high-risk patients. Postoperative a djuvant chemotherapy is mandatory only in bulky pathological stage II non-seminoma, but it is advisable also in patients who cannot be caref ully followed. Conclusion: The cure rates of GCT of the testis can app roach 100% in low stages and similar results can be achieved with diff erent treatment modalities, but the maximum results can be obtained in specialized centers only.