Is surveillance for stage 1 germ cell tumours of the testis appropriate outside a specialist centre?

Objective. To assess the results of treatment for stage 1 germ cell tumours of the testis, outside a specialist centre. Patients and methods. From May 1984 until March 1996, 123 patients with sta ge 1 disease were treated at our institution. Sixty patients with seminoma and 31 with teratoma were treated with orchidectomy only and surveillance; 32 patients with stage 1 seminoma elected for orchidectomy and adjuvant rad iotherapy. The mean ages were 40, 31 and 35 years, and the median follow-up 52, 47 and 49 months, respectively. Results. There were no disease- or treatment-related deaths. However, 18 (3 0%) patients with seminoma treated by orchidectomy only relapsed (median ti me 8 months, range 3-19); 14 of these responded to radiotherapy, three to r adiotherapy and chemotherapy for second relapses outside the irradiated fie lds, and one to chemotherapy initially, for large-volume relapse. Fifteen ( 48%) patients with teratoma relapsed (median time 3 months, range 1-12); al l responded to 4-6 courses of bleomycin/etoposide/cisplatin chemotherapy. O ne patient had a second relapse and is currently disease-free 3 years after surgical excision of a lung metastasis. Conclusion. These results show that stage 1 testis tumours can be managed s uccessfully in a district general hospital. However, we are concerned about the high relapse rates and are now attempting to identify patients at grea ter risk of recurrence, to consider adjuvant therapy in this group.