Testicular germ cell tumors, an update - Results of the German cooperativestudies 1982-997

Background: Oncologic treatment of childhood testicular germ cell tumors ca n be regarded as a model of curable neoplasm. Over 50% of the tumors are st age I A? produce alpha-fetoprotein and thus provide after semicastration a "wait and see" policy. Patients: The MAHO 82, 88, 94 cooperative studies registered between 1982 a nd 1997 197 patients, 110 patients had yolk sac tumors (YST), 47 differenti ated teratomas (TD), 38 malignant teratomas of either intermediate (MTI), u ndifferentiated (MTU), or trophoblastic type (MTT) and two seminomas. After semicastration only 65 patients received standard chemotherapy according t o stage and histology consisting of four courses of vinblastine, bleomycin and cisplatin. If after two courses viable tumor was indicated, delayed lap arotomy was performed (seven patients). Patients with incomplete tumor resp onse after two courses received three courses of etoposide, ifosfamide and cisplatin (nine patients). Results: 105 patients had YST stage I, five higher stages of disease. One o f these died by tumor progression. Of 91 patients followed according to "wa it and see" only 14 needed standard chemotherapy. The NED of 105 patients i s 99%. 47 patients had TD stage I; the NED is 100%. 13 patients had maligna nt teratomas stage I. 13 patients had stage II and received chemotherapy; t he NED for these 26 patients is 100%. 12 patients had stages III or IV, fou r died. Conclusion: In testicular germ cell tumors of childhood in alpha-fetoprotei n producing tumors of stage I A a "wait and see" program is safe. X-irradia tion or primary lymphadenectomy can be omitted since chemotherapy alone rev eals excellent results.