The role of adjuvant treatment in low-stage germ cell testicular tumors.

OBJECTIVE

To find out up-to-date indications to adjuvant therapy in low-stage germ cell tumors (GCT) of the testis.

METHODS

The authors reviewed the material of the National Cancer Institute in Milan and the major international papers on adjuvant therapies of GCT of the testis.

RESULTS

Moderate dose irradiation of retroperitoneal nodes remains the standard therapy of stage I seminoma; mediastinal irradiation has been abandoned in stage II seminoma. Nerve-sparing retroperitoneal lymph node dissection and surveillance remain standard therapies for nonseminomatous stage I tumors; 2 adjuvant courses of cisplatin-based chemotherapy are under investigation in high-risk patients. Postoperative adjuvant chemotherapy is mandatory only in bulky pathological stage II non-seminoma, but it is advisable also in patients who cannot be carefully followed.

CONCLUSION

The cure rates of GCT of the testis can approach 100% in low stages and similar results can be achieved with different treatment modalities, but the maximum results can be obtained in specialized centers only.