Stage III germinal testis tumors: aggressive approach.
We used aggressive individualized combinations of operation and cyclic actinomycin D therapy and/or irradiation for 12 patients with stage III germinal testis tumors, including 1 seminoma. Eight patients have survived free of tumor for 24 to 83 months. All but 1 survivor had retroperitoneal lymphadenectomy. Five thoracotomies and 4 neck resections were used to manage distant metastic lesions. Cyclic actinomycin D was used in 7 of 8 survivors. The experience with this series and a review of cases in the literature strongly suggest the need to eradicate the most common source of tumor seeding the distant metastatic sites from the retroperitoneal lymphatics. Eradication can best be accomplished by retroperitoneal lymphadenectomy and is indicated even in patients with a complete response to chemotherapy. A general treatment plan is suggested for stage III testis tumors: selective irradiation and chemotherapy for seminoma and an aggressive individualized combination of operation and chemotherapy with irradiation in some instances for non-seminomatous disease.
D002822:Choriocarcinoma / Q000473:pathology; D006063:Chorionic Gonadotropin / Q000097:blood / Q000652:urine; D003609:Dactinomycin / Q000627:therapeutic use; D004407:Dysgerminoma / Q000473:pathology; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D009362:Neoplasm Metastasis; D011379:Prognosis; D011879:Radiotherapy Dosage; D013724:Teratoma / Q000473:pathology; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D013737:Testis / Q000473:pathology
D006063:Chorionic Gonadotropin; D003609:Dactinomycin