PRIMARY CHEMOTHERAPY FOR STAGE-II NONSEMINOMATOUS GERM-CELL TUMORS OFTHE TESTIS

Between 1979 and 1989, 122 patients with clinical stage II testicular nonseminoma were treated with primary platinum-based combination chemo therapy following orchiectomy. Of the patients 58 had Royal Marsden Ho spital stage IIA (nodes less than 2 cm. in diameter) and the other 64 had stage IIB (nodes 2 to 5 cm. diameter) disease. With a median follo wup after chemotherapy of 5.5 years, 118 patients (97%) were disease-f ree. Two patients died of progressive germ cell tumors, 1 of bleomycin toxicity and 1 of coincidental disease. The 5-year actuarial survival probability was 95% (95% confidence intervals 91 to 99%) and the 5-ye ar failure-free survival probability was 92% (95% confidence intervals 88 to 97%). Tumor substage was not predictive of relapse but did indi cate the probability of lymphadenectomy for a post-chemotherapy residu al mass since this was performed in 17% of the patients with stage IIA disease and 39% with stage IIB disease (p < 0.05). Resected specimens contained mature teratoma (29), necrosis alone (5) or embryonal carci noma (1). We conclude that for these clinical stages primary chemother apy was as effective as primary lymph node dissection and a major oper ation was avoided in 68% of the cases.