ADJUVANT CHEMOTHERAPY AFTER ORCHIECTOMY IN HIGH-RISK PATIENTS WITH CLINICAL STAGE-1 NONSEMINOMATOUS TESTICULAR CANCER

In patients with clinical stage I non-seminomatous germ cell tumor the relapse rate seen after orchiectomy alone is approximately 30%. If re troperitoneal lymph node dissection is adopted the relapse rate in pat ients with histologically negative retroperitoneal nodes is reduced to approximately 10%. Nevertheless, follow-up is still mandatory and 70- 80% of clinical stage I patients undergo unnecessary surgery. Metastas es and relapses are mostly seen in patients with histological evidence of vascular invasion, growth beyond the testicular capsule and/or emb ryonal carcinoma in the primary tumor. We conducted a prospective tria l of two cycles of cisplatin-based adjuvant chemotherapy for 43 patien ts with clinical stage I non-seminomatous germ cell tumors and at leas t one of these risk factors (vascular invasion n = 5, pT> 1 n = 21, em bryonal carcinoma n = 42). After a median follow-up of 42 months (12-8 2 months) 40/41 patients (97.5%) who received the planned chemotherapy remain relapse-free. One patient had surgical excision of a mature te ratoma in the ipsilateral iliac region 26 months after orchiectomy and is now disease-free without further treatment after 25+ months. No li fe-threatening toxicity from chemotherapy was encountered. Two patient s who refused the chemotherapy relapsed. In patients with high-risk cl inical stage I non-seminomatous testicular cancer two cycles of adjuva nt chemotherapy are highly effective in preventing relapses and may be used as an alternative to a 'wait and watch' program or retroperitone al lymph node dissection, particularly in patients with a compromised follow-up.