EFFECT OF CHEMOTHERAPY ON CARCINOMA IN-SITU OF THE TESTIS

Background. Approximately 5% of patients with testicular cancer harbou r carcinoma in situ (CIS) in the contralateral testis. CIS will progre ss into invasive tumour in about 50% of cases within five years. The p resent study evaluated the effect of platinum containing chemotherapy on CIS. Patients and methods. Thirty-three patients with disseminated germ-cell cancer and biopsy proven CIS of the testis were evaluated. R esults. CIS had disappeared in the first follow-up biopsy in 30 patien ts. Six patients had a relapse of CIS with or without invasive cancer after 30. 31, 47, 51, 76 and 95 months from start of chemotherapy. Two relapses were among six patients who initially received cisplatin, vi nblastine and bleomycine and four among 27 patients who initially rece ived cisplatin, etoposide and bleomycine. The estimated cumulative ris k of CIS five and 10 years after chemotherapy was 21% and 42%. respect ively The estimated cumulative incidence of spermatogenesis was 64% an d 81% at five and 10 years of follow-up, respectively. Conclusion: Pla tinum containing chemotherapy may eradicate CIS. However, patients wit h CIS may develop invasive cancer in spite of chemotherapy. In the lig ht of the present data, we recommend radiotherapy to the affected test icle in patients with CIS in the contralateral testis and in patients with bilateral testicular CIS. In patients with extragonadal disease a nd CIS in one testicle, orchiectomy of the affected testicle is recomm ended. In patients for whom future fertility is an important issue, fo llow-up including repeated biopsies can be offered for a period of at least 10 years.