INTRATESTICULAR EFFECTS OF CISPLATIN-BASED CHEMOTHERAPY

The question is addressed whether cisplatin-based chemotherapy for ger m cell cancer has the same efficacy in intratesticular and in extragon adal sites. For this purpose, 7 patients with germ cell cancer, aged 1 6-35 years were analysed. Four of the patients had palpable testicular tumors, 3 had occult testicular tumors. All presented with advanced d isease and therefore received chemotherapy as the first step of treatm ent. Orchiectomy was done in the later course. A significant clinical response to chemotherapy was observed at the intratesticular tumor sit e as well as at extragonadal sites in all patients. Orchiectomy specim ens contained viable cancerous cells in 2 patients after two courses o f chemotherapy while in 5 patients no invasive germ cell cancer was fo und. Severe depression of germ cells was observed in all specimens. Te sticular intraepithelial neoplasia (TIN; carcinoma in situ) persisted in 4 patients, 1 of whom also had viable cancerous cells in the specim en. Cisplatin-based chemotherapy is also active in intratesticular tum ors but there seems to be a slightly different response of metastatic germ cell cancer and intratesticular tumor. Tumor heterogeneity appear s to be the most important reason for this different response. The low er response of TIN to chemotherapy as compared to invasive testicular cancer is probably due to a genetically determined lower sensitivity. The blood-testis barrier might contribute a minor part to this phenome non by modulating the intratubular concentrations of cytostatic compou nds. The efficacy of cisplatin-based chemotherapy on invasive intrates ticular tumors is not compromised by the blood-testis barrier. Primari ly because of the possible persistence of TIN, all patients receiving chemotherapy as the initial step of treatment for metastatic testicula r germ cell tumor should undergo orchiectomy even if there is complete systemic response.