Two contributions to the management of non-seminomatous germinal tumors of the testis are reviewed. First, a midline technique of extended retroperitoneal lymph node dissection has been developed, allowing good access to both renal suprahilar zones as well as the traditional hilar and infrahilar areas. This technique has been used at our medical center to stage embryonal carcinoma or teratocarcinoma of the testis in patients who had negative preoperative chest tomography. Of 58 consecutive patients seen from 1965 to 1975, 30 had stage A disease and 28 had stage B. All 30 patients with stage A disease survived (100 per cent) and 24 of 28 patients with stage B disease survived (86 per cent), for an over-all survival rate of 93 per cent. The second contribution relates to the development of a new combination chemotherapy protocol for patients with stage C disease. Preoperative stage C lesions are treated with platinum, vinblastine sulfate and bleomycin. Patients who achieve clearance of pulmonary tumors but who have anatomic or serologic evidence of persistent retroperitoneal tumor after this chemotherapy are later treated with retroperitoneal lymph node dissection. Of 12 such patients 6 have been rendered free of tumor and now enjoy complete remission. Furthermore, 33 of 50 patients (66 per cent) with disseminated stage C disease achieved initial complete remission using this drug combination. Of the 50 patients 26 remain in continuous complete remission with no evidence of disease for 2 to 4 years, 7 are alive and in partial remission and 17 are dead. Improved chemotherapy opens alternative methods to manage advanced testis cancer.
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