The clinical significance of unconventional orchiectomy approaches in testicular cancer: a report from the Testicular Cancer Intergroup Study.
Despite the clear indications for an inguinal approach, reports indicate that up to 53 per cent of all testicular tumors are diagnosed or initially treated in a manner inconsistent with the classical radical orchiectomy. Of 462 evaluable patients from the Testicular Cancer Intergroup Study 47 (10.2 per cent) had undergone a nonclassical orchiectomy as the initial surgical management. This group was analyzed separately to determine the prognostic significance of needle aspiration, open biopsy, a scrotal approach and tumor contamination. Within this group of patients, those who received no adjuvant chemotherapy exhibited no increase in local or distant recurrence. While the recurrence rate similarly was not adversely affected by even gross tumor contamination, this subset underwent significantly more aggressive local surgical salvage (p less than 0.01), with scrotectomy procedures found to be of probable therapeutic value. While not to be condoned, we conclude that deviations from the classical orchiectomy, when followed by appropriate surgical management and close observation, can be of little clinical impact.
Giguere
J K
JK
Section of Medical Oncology, Walter Reed Army Medical Center, Washington, D.C. 20307.
Stablein
D M
DM
Spaulding
J T
JT
McLeod
D G
DG
Paulson
D F
DF
Weiss
R B
RB
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001707:Biopsy, Needle; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009366:Neoplasm Seeding; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000601:surgery*; D009919:Orchiectomy / Q000379:methods*; D011379:Prognosis; D012307:Risk Factors; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000601:surgery*; D014481:United States
D000970:Antineoplastic Agents