Role of primary chemotherapy in stage I and low-volume stage II nonseminomatous germ-cell testis tumors.

After many years of debate, it has been established that radiation, retroperitoneal lymphadenectomy, and close surveillance all lead to excellent survival rates in patients with stage I nonseminomatous germ-cell tumors. Retroperitoneal lymphadenectomy may be particularly appropriate for patients seen in referral centers to which patients cannot easily return for regular follow-up. A growing understanding of prognostic factors has provided the stimulus for a third option, adjuvant chemotherapy after orchiectomy in high-risk patients. Quality of life issues must ultimately be considered when evaluating treatment options. For small-volume stage II disease, retroperitoneal lymphadenectomy is the current standard in the United States. Adjuvant chemotherapy may be given, but observation with chemotherapy for relapse is also feasible. In Europe, initial chemotherapy with later lymphadenectomy if necessary is the usual approach.