title: Evolution and controversies in the management of low-stage nonseminomatous germ-cell tumors of the testis.
abstract: The results of changing treatment modalities in 690 consecutive patients with low stages nonseminomatous germ-cell tumors (NSGCT) of the testis were analyzed. Overall, 120 patients (17.4%) suffered relapses, and 25 (3.6%) died of cancer after a follow-up period ranging from 2 to 20 years. The indications for primary (nerve-sparing) retroperitoneal lymph-node dissection (RPLND) were gradually restricted from clinical stages I, IIA, and IIB to stages I and IIA with normal postorchiectomy markers only, but we recognize that the management of clinical stage I NSGCT of the testis remains controversial. All other patients may be treated with primary chemotherapy followed by nerve-sparing RPLND for any residual mass. Adjuvant chemotherapy is mandatory in pathological stage IIC disease, but this pathological category will disappear with adoption of the restrictions for primary nerve-sparing RPLND, and two courses of adjuvant chemotherapy are adequate treatment for patients with pathological stages IIA and IIB disease, who cannot be carefully followed.
authors.affiliation: Division of Urologic Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pizzocaro
authors.forename: N
authors.initials: N
authors.lastname: Nicolai
authors.forename: R
authors.initials: R
authors.lastname: Salvioni
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D018237:Germinoma / Q000175:diagnosis / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008220:Lymphography; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D009919:Orchiectomy; D012074:Remission Induction; D012186:Retroperitoneal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014567:Urography; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D001761:Bleomycin; D014747:Vinblastine; D002945:Cisplatin