THERAPY FOR NONSEMINOMATOUS GERM-CELL TUM ORS IN CLINICAL STAGE-IIA B(PT+N1/2MO)/

In theses stages standard therapy (RLND + 2 courses PEB) reveals survi val rates of more than 95%. The high rates of toxic side effects from two aggressive treatment strategies induce considerations about reduci ng therapy. We may be able to omit one of the therapeutic methods: (a) RLND alone can cure half of the patients; the others could have chemo therapy if progression is found. (b) Primary chemotherapy shows comple te remission in 75% of the cases; only every fourth patient has to und ergo surgical resection of a residual tumor. Survival rates for both s trategies are no different than those following standard therapy. Furt her modifications concern surgical techniques (modified unilateral RLN D, nerve sparing RLND) in order to preserve an antegrade ejaculation, as well as other chemotherapy regimens by omitting one of the drugs (P E instead of PEB) or replacing one by another with fewer toxic effects (CEB instead of PEB). Current clinical trials should answer the quest ion of which of the therapeutic options impairs quality of life less.