Clinical characteristics of metachronous bilateral testicular tumors in the chemotherapeutic era

We wanted to present the results of our experience with bilateral testis tu mor and to suggest the effects of chemotherapy in suppressing the developme nt of second primary testicular tumors. Between 1978 and 1997,2,345 patient s were treated for testicular tumor at The University of Texas hi. D. Ander son Cancer Center. Of these, 2,107 had germ cell cancers. There were 22 (0. 94%) cases of bilateral testicular tumor in the overall patient population and 21 (1.0%) cases among patients with germ cell cancer. We reviewed the m edical records to determine the incidence of the histological subtype, the incidence of metachronous versus synchronous formation of contralateral tum ors, and tumor stage in this patient population. We also examined the effec t of chemotherapy in treating the first tumor and preventing the occurrence of a second tumor. Finally, we compared the effect of ultrasonography, ser um tumor marker elevation, and physical examination in detecting second tum ors. Only one contralateral germ cell tumor developed synchronously; all ot hers developed metachronously. Fifty percent of first tumors were seminomas , compared to 55% of second tumors. The histologic concordance rate for fir st and second rumors was 35%. Tumor stage was higher among first tumors tha n second tumors. The majority of second tumors in patients who received che motherapy for first malignancies tended to be metachronous seminomas. Ultra sonography detected 6 of 21 (28.6%;) contralateral tumors before they were evident by physical examination or serum tumor marker elevation. Seminomas were more prevalent among patients with bilateral germ cell disease than pa tients with unilateral disease. Chemotherapy, when used as treatment for fi rst tumors, may have some effect in preventing the development of nonsemino matous germ cell tumors in the contralateral testicle. Close follow-up of t he contralateral testis with ultrasonography is essential for early detecti on of second rumors. The outcome for patients with bilateral testicular ger m cell cancer is excellent, secondary ro early detection.