EVOLUTION AND CONTROVERSIES IN THE MANAGEMENT OF LOW-STAGE NONSEMINOMATOUS GERM-CELL TUMORS OF THE TESTIS

The results of changing treatment modalities in 690 consecutive patien ts with low stages nonseminomatous germ-cell tumors (NSGCT) of the tes tis were analyzed. Overall, 120 patients (17.4%) suffered relapses, an d 25 (3.6%) died of cancer after a follow-up period ranging from 2 to 20 years. The indications for primary (nerve-sparing) retroperitoneal lymph-node dissection (RPLND) were gradually restricted from clinical stages I, IIA, and IIB to stages I and IIA with normal postorchiectomy markers only, but we recognize that the management of clinical stage I NSGCT of the testis remains controversial. All other patients may be treated with primary chemotherapy followed by nerve-sparing RPLND for any residual mass. Adjuvant chemotherapy is mandatory in pathological stage IIC disease, but this pathological category will disappear with adoption of the restrictions for primary nerve-sparing RPLND, and two courses of adjuvant chemotherapy are adequate treatment for patients with pathological stages IIA and IIB disease, who cannot be carefully followed.