Expectant therapy for clinical stage A nonseminomatous germ-cell cancers of the testis? A qualified ?Yes?

Abstract

Most patients with testicular cancer can ultimately be cured. In early-stage disease, retroperitoneal lymph node dissection or radiotherapy can cure more than 90% of patients, and chemotherapy is associated with long-term remission in 60% to more than 90% of patients with metastases, depending on the extent of disease. Because of the high salvage rate with chemotherapy, efforts are now being directed toward reducing the toxicity of primary management. In several centers, a “surveillance” policy for selected patients with clinical Stage A nonseminomatous germ-cell tumors appears to be safe: 80% of these patients may be cured by orchiectomy alone, thus avoiding the adverse effects of lymph node dissection or radiotherapy; the remaining 20% will require chemotherapy. This approach should be used only in referral centers with a specialty interest in testicular cancer and excellent facilities for monitoring and followup.