THE MANAGEMENT OF PATIENTS WITH NONSEMINOMATOUS GERM-CELL TUMORS OF THE TESTIS WITH SEROLOGIC DISEASE ONLY AFTER ORCHIECTOMY

Management of patients with nonseminomatous germ cell tumors of the te stis who have persistently elevated serum tumor marker levels (alpha-f etoprotein and/or human chorionic gonadotropin) following orchiectomy and no clinical evidence of disease is controversial. We reviewed our experience with 15 such patients at our cancer center between March 19 77 and November 1991. Group 1 (II patients) underwent initial retroper itoneal lymph node dissection and group 2 (4 patients) received primar y chemotherapy. All group 1 patients required subsequent chemotherapy for retroperitoneal disease or persistent marker elevation, whereas on ly 1 of the 4 who received primary chemotherapy required later surgery . We conclude that tumor marker elevation in this setting is usually i ndicative of systemic tumor, which is best treated primarily by initia l chemotherapy.