A CONSERVATIVE APPROACH TO BILATERAL TESTICULAR GERM-CELL TUMORS

We report on 6 patients with bilateral testicular germ cell tumors tre ated by organ sparing surgery. Tumors 6 to 30 mm. in diameter were enu cleated, and biopsies of the tumor bed and peripheral parenchyma were taken. Histological examination revealed seminoma in 4 cases, embryona l carcinoma in 1 and a Leydig cell tumor in 1. All patients underwent testicular radiation therapy with 20 Gy. for carcinoma in situ. A test icular biopsy was performed 6 months postoperatively to evaluate thera peutic success. Median followup was 43 months, all patients were free of disease and there was no local recurrence. Luteinizing hormone and testosterone were within the normal range and no androgen substitution was necessary. Our study suggests that organ sparing surgery for bila teral testicular germ cell tumors represents a new therapeutic approac h with endocrinological and psychological advantages. In our experienc e conservative surgery is possible under certain prerequisites, includ ing organ confined tumor without infiltration of the rete testis, obta ining multiple biopsies of the tumor bed and peripheral parenchyma, as sociated carcinoma in situ treated by radiation therapy and close foll owup of patients.