CHEMOTHERAPY OF TESTICULAR-TUMORS

Even 15 years after the introduction of cisplatin in Germany many ques tions remain unanswered with regard to the optimal treatment of testic ular tumors. Various staging systems make it difficult to compare the treatment results of clinical trials. Nonseminomatous tumors and semin omas have a distinct biological behavior and are therefore described s eparately. In clinical stage I disease of nonseminomatous tumors adjuv ant chemotherapy presently can not be regarded as standard, while it h as proven effective in surgically treated stage IIA/B disease; in latt er stage primary chemotherapy recently is considered more often. In go od risk metastatic disease of nonseminomatous tumors a combination con sisting of cisplatin, etoposide, and bleomycin remains standard therap y; omission of bleomycin or substitution of carboplatin for cisplatin leads to inferior treatment results. Patients with poor risk metastati c disease of nonseminomatous tumors should be treated only at speciali st units and in clinical trials, since treatment results are still uns atisfactory. The role of carboplatin single agent treatment compared t o cisplatin-based combination chemotherapy for advanced seminoma prese ntly is examined in a randomized clinical trial. Relapsing or refracto ry testicular tumors are cured by conventional salvage chemotherapy in a relatively low percentage. Patients undergoing high dose chemothera py after multiple relapses have only a low chance of cure. Trials with inclusion of large numbers of patients are necessary to define an opt imal stage-adapted treatment of testicular tumors.