Editorial comment

Abstract

RPLND in patients with high-risk Stage 1 NSGCTT is associated with a 42% relapse rate after surgery. 1 Swanson D, Eschenbach A, Babaian R, et al: Is retroperitoneal lymph node dissection (RLND) alone optimal or sufficient therapy for clinical stage 1 nonseminomatous germ cell testicular tumours. J Urol 159 (Proc AUA suppl 5): 179, 1999 Google Scholar Patients with Stage I seminoma after radiotherapy have a greater than 15% incidence of second cancers after 20 years of follow-up. 2 van Leeuwen F.E. Stiggelbout A.M. Vandenbeltdusebout A.W. et al. Second tumours after radiation treatment of testicular germ-cell tumors. J Clin Oncol. 1993; 11: 2286-2287 Google Scholar Surveillance for all and chemotherapy for relapse, despite such a policy's risk of defaulting patients and a 20% to 35% relapse rate, produces a survival rate of greater than 98% at 5 years. 3 Freedman L.S. Parkinson M.C. Jones W.G. et al. MRC Testicular Tumour Subgroup (Urological Working Party)Histopathology in the prediction of relapse of patients with stage 1 testicular teratoma treated by orchidectomy alone. Lancet. 1987; 2: 294-298 Abstract Scopus (327) Google Scholar , 4 Warde P. Specht L. Horwich A. et al. Prognostic factors for relapse in stage I testicular seminoma managed by surveillance a pooled analysis. J Clin Oncol. 2002; 20: 4448-4452 Crossref Scopus (451) Google Scholar As a consequence, such a policy could, by default, be considered today's least-risk-associated standard of care for all Stage I germ cell cancers whatever the histologic subtype.