Recurrence patterns in the non-seminomatous germinal testicular tumors

Abstract

The authors have evaluated 80 consecutive patients with non-seminomatous testes tumor by studying local recurrence patterns in both surgical and irradiated regions to judge the relative effectiveness of these therapeutic modalities. Employing this analysis, there were 6 patients of 32 failures in the N0, N1–N2, N3 and N4 categories who migbt have benefited by more intensive irradiation to nodal areas because of a failure to disseminate in less than 1 year. In the N1–N2 patients, 12 of 14 successes were in the 3500–4500 rad region. Recommendations for treatment are as follows: 1. 1. Patients with negative nodes (N0) require adequate retroperitoneal node dissection alone. 2. 2. Patients with resectable histologically involved nodes (N1–N2) should probably receive post-operative radiotherapy to the involved retroperitoneal region with doses of 5000–5500 rad. 3. 3. Unresectable retroperitonal lymph node disease (N3) probably requires a systemic approach with localized irradiation administered to the involved nodes only. 4. 4. Patients presenting with supradipharagmatic disease (N4 or M1b & M1c) have disseminated tumor and radiotherapy is used for palliation of local masses not controlled by chemotherapy. 5. 5. Prophylactic mediastinal irradiation is not routinely indicated in any stage of the disease.