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Evolving Therapeutic Options

Jerome P. Richie, MD; Mark A. Socinsky, MD; Claire Y. Fung, MD; Gilbert L. Brodsky, MD; Leslie A. Kalish, PhD; Marc B. Garnick, MD

Arch Surg. 1987;122(12):1443-1445.

Abstract
• Eighty patients with clinical stage I or II nonseminomatous germ cell tumors of the testis were managed with modified protocols, including modified nerve-sparing retroperitoneal lymph node dissection for patients with stage I cancer, retroperitoneal lymph node dissection for patients with low-volume stage II cancer, and initial chemotherapy with or without subsequent retroperitoneal lymphadenectomy for patients with high-volume stage II cancer. Patients with low-stage disease (clinical stage I) were treated successfully with modified retroperitoneal lymph node dissection (relapse rate, three of 40 patients). Clinical understaging was evidenced in 14 of 48 patients with clinical stage I disease who were found to have pathologic involvement of the retroperitoneal lymph nodes, including six patients with extensive retroperitoneal nodal involvement (pathologic stage B2). Of nine patients with retroperitoneal tumors less than 3 cm in diameter, four patients were satisfactorily treated with retroperitoneal lymph node dissection alone while five patients required chemotherapy after retroperitoneal lymph node dissection. Of 26 patients with retroperitoneal tumors 3 to 5 cm in diameter, 17 patients were treated with chemotherapy alone. All patients remain free of disease after the completion of definitive therapy. We conclude that therapeutic options should be modified based on histologic factors in the primary tumor, extent of retroperitoneal disease as indicated on a computed tomographic scan, and presence or absence of elevated tumor markers. By consideration these factors, optimum therapy can be selected to achieve the highest long-term survival rate with the least morbidity.

(Arch Surg 1987;122:1443-1445)

Author Affiliations
From the Department of Surgery/Urology, Brigham and Women's Hospital (Drs Richie and Brodsky), Division of Medical Oncology, the Dana Farber Cancer Institute (Drs Socinsky, Fung, Kalish, and Garnick), and Harvard Medical School, Boston.

Footnotes
Accepted for publication July 29, 1987.

Read before the Annual Meeting of the Society of Surgical Oncology, London, April 28, 1987.

Reprint requests to Department of Surgery/Urology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (Dr Richie).

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