Adjuvant chemotherapy combination of vinblastine, actinomycin D, Bleomycin, and Chlorambucil following retroperitoneal lymph node dissection for stage II testis tumor.

In an attempt to reduce recurrence of nonseminomatous germ cell tumors of testis stage II, 62 patients were treated with vinblastine, actinomycin D, bleomycin, and chlorambucil after retroperitoneal lymph node dissection. Of the patients, 84% have remained in complete remission with median follow-up of three years: 33/33 stage II-A (N-1,N-2A) and 19/29 (66%) stage II-B (N-2B,N3). The relapse rate in patients who had histologic evidence of extranodal extension of the tumor (N-3) was 54% (7/13). This program did not cause any serious toxicity. Adjuvant chemotherapy is effective in reducing relapses. More recently, with the current availability of chemotherapy with a high efficacy for control of disseminated disease, patients with resected stage II-A (N-1,N2A) have been followed closely and treated only if they developed evidence of recurrence. Patients with resected stage II-B (N-2B,N-3) have been placed on a more aggressive adjuvant program.