We believe that 'standard' therapy for clinical stage I nonseminomatous testes germ cell tumors (NSGCT) patients continues to be extended bilateral retroperitoneal lymphadenectomy including suprahilar dissection (RPLND). This approach yields cure rates unparalleled in cancer treatment, with negligible treatment mortality and the avoidance of systemic therapy in most patients. Pathologic stage II patients are identified and managed accordingly, with RPLND being potentially curative in these patients. Excluding reproductive function, long-term complications are nearly zero after RPLND. Sterility is a problem but it has been overemphasized and may be reduced by relatively minor operative modification. Option 2 (radiation), we believe, might be reasonable for the rare patient who has unacceptably high operative risk, but long-term complications and a possible inferior therapeutic result make it much less desirable. Option 3 (chemotherapy only) exposes too many patients to systemic therapy and, we believe, has an unacceptable morbidity and mortality compared to option 1. Option 4 (observation) has for us a great deal of appeal for obvious reasons. However, its success is unknown in terms of likelihood of cure. It is not 'standard' therapy and should be offered only in the context of a prospective clinical trial, several of which are currently in progress. Clearly, better staging techniques would be highly desirable. Ultimately, we hope option 4 will succeed option I as preferred management, but that time has not yet arrived. Finally, we believe that success in the management of these patients is contingent upon the availability of experienced physicians of numerous disciplines. All patients should be treated by such individuals, and the rarity of this disease makes such referrals realistic.
|Original language||English (US)|
|Number of pages||4|
|Journal||Cancer Treatment Reports|
|State||Published - Jan 1 1982|
ASJC Scopus subject areas
- Cancer Research