Chemotherapy in stage II nonseminomatous germ cell tumors of the testis: The institut Gustave roussy experience

To assess the role of chemotherapy in the treatment of stage II nonseminomatous germ-cell tumors of the testis, the outcomes of 154 patients who were included in prospective trials and standard treatment programs at Institut Gustave Roussy between 1984 and 1993 were reviewed. The median follow-up is 5.5 years. Cisplatin-based primary chemotherapy was the treatment regimen for 108 patients. Elevated serum tumor marker levels were found in 27 patients only while 81 had radiologic evidence of retroperitoneal disease. Primary chemotherapy was followed by retroperitoneal lymph node dissection (RPLND) in 41 % of cases. Long-term nonevolutive disease (NED) was diagnosed in 101 (93%) patients. Primary RPLND and adjuvant chemotherapy was the treatment regimen for 46 patients, 100% of whom are long-term NED. ts with normal serum tumor marker levels following orchiectomy and radiologic evidence of low volume retroperitoneal disease should undergo primary RPLND. Patients with persistently elevated serum tumor marker levels without retroperitoneal involvement should be treated by primary chemotherapy, as should patients with large volume retroperitoneal disease. In patients with elevated serum tumor marker levels and low volume retroperitoneal disease who may benefit equally from up-front chemotherapy or primary RPLND, assessment of risk-benefit, cost-benefit, and quality of life is warranted in future trials.